This first part of the lecture summarizes current data obtained from studies of cohorts of HIV-infected patients presenting with clinical signs of musculoskeletal and skin involvement. The rheumatologic manifestations of HIV infection are diverse and, as shown in several studies conducted both before and after the widespread introduction of antiretroviral therapy, occur with varying frequency. This variability can complicate familiarity with the issue, particularly for early-career clinicians. According to the literature, the most observed conditions in the context of HIV infection include rheumatoid arthritis, reactive arthritis, HIV-associated arthritis and arthralgias, spondyloarthritis, and psoriatic arthritis. The present article also discusses the occurrence of osteoporosis and osteonecrosis in these patients. Furthermore, it reviews the classification of muscle involvement in HIV infection, with a focus on cases of rhabdomyolysis of various origins.

Osteoarthritis (OA) is a prevalent rheumatic disease characterized by structural and functional joint abnormalities, leading to significant functional and quality of life impairment. Hand OA ranks second in prevalence after knee OA. This article reviews current data on the epidemiology and risk factors of hand OA, and highlights the new EULAR classification criteria, which incorporate radiographic features of generalized OA, involvement of interphalangeal joints, and OA of the first carpometacarpal joint in patients with pain, discomfort, and/or stiffness. The article also presents findings from the ISKRA study, which demonstrated the efficacy of a bioactive small marine fish concentrate in 2,776 patients with hand OA.

Even after the end of the COVID-19 pandemic, the SARS-CoV-2 virus continues to circulate in the population and influence the course of immune-mediated inflammatory rheumatic diseases (IMIRDs). Previous COVID-19 infection may be associated with increased IMIRD activity; however, data on the long-term post-infectious impact of COVID-19 on rheumatic disease progression remain limited.

Objective: To assess dynamics of IMIRDs course in patients with a history of COVID-19, based on individual disease activity indices measured at 3, 6, and 12 months after infection.

Material and Methods. A retrospective-prospective cohort study included 100 patients with IMIRDs (rheumatoid arthritis [RA], systemic lupus erythematosus, systemic sclerosis, and ankylosing spondylitis) who had experienced COVID-19. Disease activity was assessed using validated indices: DAS28, SLEDAI-2K, modified Valentini index, and ASDAS. Data were analyzed using nonparametric statistical methods and performance analysis (ROC-analysis).

Results and discussion. At 3 months post-COVID-19, high or very high disease activity was noted in 51% of patients; at 12 months, activity decreased to 38.8%. Persistent high disease activity was observed in 18% of patients throughout the follow-up period, most commonly in RA patients. Risk factors for experiencing ≥2 disease flares included a history of COVID-19-associated pneumonia (odds ratio [OR] 7.1; 95% confidence interval [CI] 1.6–32.2; p=0.011) and comorbid pathology (OR 6.7; 95% CI 1.3–34.9; p=0.024). The prognostic model demonstrated high diagnostic accuracy: sensitivity 89.4%, specificity 82.5%.

Conclusions. Previous COVID-19 infection is associated with a high frequency of IMIRD flares, particularly during the early post-infection months. Development of a risk stratification model may optimize patient management in the post-COVID period.

Objective: to evaluate the efficacy, safety, and treatment persistence of netakimab (NTK) in patients with active psoriatic arthritis (PsA) in realworld clinical practice at 52 weeks of follow-up.

Material and methods. This observational prospective cohort study included 149 patients with active PsA receiving NTK treatment in accordance with clinical guidelines. As of the data cut-off (April 21, 2025), the median follow-up duration was 63 weeks (range: 22–117 weeks). The primary endpoint was treatment persistence with NTK. Safety and tolerability were assessed through the documentation of adverse events (AEs).

Results and discussion. By week 52, treatment persistence with NTK reached 96.0%. At the time of analysis, 12 (8.1%) out of 149 patients had discontinued NTK, with lack of efficacy reported in 9 cases. By week 52, only 2 AEs had been recorded, and just 1 was considered related to NTK.

Conclusion. Over the 1-year observation period, NTK demonstrated a high treatment persistence rate, efficacy, and an acceptable safety profile in patients with PsA in real-world clinical practice.

Objective: to assess bone mineral density (BMD), trabecular bone score (TBS), and their relationship with serum uric acid (UA) levels in women with rheumatoid arthritis (RA).

Material and methods. The study included 165 women with confirmed RA (median age 63.0 [54.0; 68.0] years). All participants underwent clinical and laboratory evaluation, including serum UA level measurement and dual-energy X-ray absorptiometry (DXA) to assess BMD at the lumbar spine (LI-IV), femoral neck (FN), and total hip (TH). TBS was determined for all patients based on LI-IV BMD measurements.

Results and discussion. The mean UA level was 265.9±73.2 μmol/L. A positive correlation was observed between UA level and BMD at the TH (r=0.18, p=0.023), and a negative correlation was found between UA level and TBS (r=-0.25, p=0.001). In multivariate regression analysis, a significant independent association of UA level with both BMD across all measured sites and TBS was identified in postmenopausal women (p<0.05). No significant associations were observed in premenopausal women. Conclusion. In postmenopausal women with RA, serum UA levels showed a positive independent association with BMD and a negative association with TBS. No such relationship was observed in women of reproductive age. Keywords: bone mineral density; trabecular bone score; uric acid; rheumatoid arthritis> < 0.05). No significant associations were observed in premenopausal women.

Conclusion. In postmenopausal women with RA, serum UA levels showed a positive independent association with BMD and a negative association with TBS. No such relationship was observed in women of reproductive age.

Hyperuricemia (HU) and gout are metabolic conditions associated with an elevated risk of developing renal, cardiovascular, and metabolic comorbidities and complications. Recent findings show that both HU and gout are more prevalent in patients with rheumatoid arthritis (RA) than previously thought and may have important long-term implications for both RA and overall health. However, in daily clinical practice, the potential impact of HU and/or gout on RA activity and therapy, especially in the context of multiple comorbidities remains insufficiently explored.

Objective: to evaluate in real-world clinical practice the impact of gout/HU on the activity and severity of RA, the specifics of its pharmacotherapy, and the profile of metabolic disorders and comorbidities in patients with active RA and coexisting HU.

Material and methods. Data were analyzed from 1091 patients with confirmed RA for whom the prescription or switch to a biologic disease-modifying antirheumatic drug (bDMARD) or targeted synthetic DMARD (tsDMARD) was approved due to previous treatment failure. Patients were divided into two age- and disease-duration-matched groups based on the presence or absence of HU. Clinical and laboratory markers of RA activity, prevalence of extra-articular manifestations, severity and progression of RA, pharmacotherapy characteristics, comorbidities, metabolic syndrome (MetS) variants, and overall multimorbidity (CIRS index) were assessed.  

Results and discussion. Among patients with active RA, 15.6% had HU and 5.2% had gout. The mean serum uric acid concentration was 434.1±34.3 μmol/L (p<0.0001). Uric acid-lowering therapy was administered to 7.8% of patients. RA patients with and without HU were comparable in age, disease duration, RA activity and severity, rheumatoid factor and anti-cyclic citrullinated peptide antibody positivity, and preva-> < 0.0001). Uric acid-lowering therapy was administered to 7.8% of patients. RA patients with and without HU were comparable in age, disease duration, RA activity and severity, rheumatoid factor and anti-cyclic citrullinated peptide antibody positivity, and prevalence of extra-articular RA manifestations. Medication history was also similar in both groups, including the number/duration of use and the range of NSAIDs, glucocorticoids, conventional DMARDs, and bDMARDs/tsDMARDs used. However, patients with RA and HU more frequently had arterial hypertension, chronic kidney disease (CKD), obesity, and MetS, which significantly increased their multimorbidity burden. They were also more likely to use diuretics. Cardiovascular disease prevalence did not differ significantly between the groups.

Conclusion. The findings underscore the potential clinical importance of identifying and managing HU in RA patients, considering its strong association with comorbidities such as hypertension, CKD, MetS, and obesity.

Back pain (BP) is less common in patients with rheumatoid arthritis (RA) than in the general population. However, RA patients who do experience BP tend to have lower functional activity scores, lower general health assessments, and higher overall pain intensity. The development of osteoporosis (OP) is considered a risk factor for vertebral fractures and possibly for BP.

Objective: to identify factors influencing the onset and persistence of pain in the thoracic and lumbar spine in RA patients under long-term prospective observation.

Material and methods. This prospective, non-interventional cohort study included 151 women with RA. The mean patient age was 53.9±9.2 years; the average age at onset of BP was 53.6±12.2 years, and at RA diagnosis – 41.9±12.5 years. The average follow-up duration was 9.7±1.7 years. All patients underwent clinical, laboratory, and radiological assessments at baseline and during follow-up, including spinal radiomorphometry according to Genant, X-ray densitometry of the lumbar spine (LI–LIV), and femoral neck. Pain was assessed using the visual analogue scale (VAS).

Results and discussion. During the follow-up, the number of women with BP increased from 96 (63%) to 116 (77%), and those with lumbar pain from 77 (51%) to 101 (67%). VAS pain intensity in the thoracic spine averaged 49±18 mm at baseline and 51±16 mm at follow-up; in the lumbar spine, 47±21 mm and 51±19 mm, respectively. Pain in the thoracic spine appeared or worsened in 31 (20%) cases; in the lumbar spine, in 65 (43%). At baseline, 23 patients (62%) reported severe thoracic pain (>40 mm), and 56 (73%) reported lumbar pain; by the end of the study, these figures were 26 (60%) and 78 (77%), respectively.

Conclusion. Severe thoracic BP (>40 mm) was associated with RA activity, while lumbar pain was linked to age, daily glucocorticoid dose, DAS28 index, HAQ index, and degenerative changes in LII–LIII, LIII–LIV, and LIV–LV. No significant association was found between BP and vertebral deformities, prior peripheral fractures, bone mineral density in LI–LIV or the proximal femur, or T-scores below <-2,5.

Osteoarthritis (OA) is one of the most common joint disorders. A promising and rational treatment combination is diacerein with chondroitin sulfate (CS). Their mechanisms of action suggest a potential synergistic effect on various pathogenetic pathways of OA.

Objective: to evaluate the safety and efficacy of a combined preparation of diacerein and CS (Diaflex Chondro) in patients with knee OA.

Material and methods. The study included 180 patients with knee OA, randomized into three equal groups. Group 1 received a combination of diacerein and CS, Group 2 received diacerein monotherapy, and Group 3 received CS monotherapy. Treatment efficacy was assessed using changes in pain intensity on the Visual Analogue Scale (VAS), WOMAC scores (Pain, Stiffness, Function subscales), and the number of ibuprofen doses taken during the 16-week treatment period. The daily dosage of the combination therapy was 100 mg diacerein + 800 mg CS, compared with 1000 mg CS or 100 mg diacerein in monotherapy. Adverse events (AEs) were recorded to assess safety.

Results and discussion. The combination therapy (Diaflex Chondro) demonstrated statistically significant superiority over both monotherapy groups in reducing pain intensity (VAS and WOMAC) throughout the 16-week study. At week 4, the VAS pain reduction in Group 1 was 11.07±9.80 mm and reached 33.78±14.17 mm by week 16. In Group 2, the reduction was 9.48±13.15 mm at week 4 and 27.12±14.77 mm at week 16. In Group 3, these values were 8.05±11.31 mm and 21.87±14.57 mm, respectively. WOMAC pain scores also improved: Group 1 showed a reduction of 12.72 points at week 8 and 21.8 points at week 16; Group 2 – 9.13 and 18.35 points; Group 3 – 8.6 and 16.38 points, respectively. The need for additional ibuprofen use was significantly lower in the combination group compared to CS monotherapy (p=0.004). The average number of ibuprofen doses over 16 weeks was 13.58 ± 13.96 (combination), 19.45±15.19 (diacerein), and 27.03±22.56 (CS).

Twelve AEs were reported across the three groups, all mild and related to gastrointestinal disturbances.

Conclusion. In patients with stage II–III knee OA, the combination of diacerein and CS (Diaflex Chondro) proved more effective than either agent used alone.

Patients with systemic sclerosis (SSc) represent a heterogeneous and therapeutically challenging group. Disease progression is often associated not only with reduced quality of life but also with severe organ involvement. Despite advances in the use of biologic agents, treatment options for SSc remain limited.

Adjunctive treatment methods that target the peripheral vascular system may offer therapeutic benefit for this population. Enhanced external counterpulsation (EECP), which has shown efficacy in refractory angina, could also hold potential in systemic connective tissue diseases. Its positive impact on endothelial function suggests utility beyond cardiology in diseases where progressive microvascular remodeling and tissue hypoxia play key pathogenic roles.

This article presents a case series describing the initial experience of EECP use in 3 female patients with SSc as an adjunct to optimized pharmacological therapy.

Fibromyalgia (FM) is characterized by chronic widespread musculoskeletal pain along with a broad spectrum of associated psychosomatic manifestations, such as fatigue, sleep disturbances, generalized stiffness, depression, anxiety, and cognitive impairment. The underlying mechanism of FM is central sensitization, which is thought to arise from both congenital and acquired neuroendocrine dysfunctions, as well as autoimmune processes.

FM is among the most common comorbidities in patients with rheumatoid arthritis (RA). While the general population prevalence of FM is 2–4%, it reaches 15–30% in patients with RA (averaging about 20%). Given that the prevalence of FM in early RA is much lower (4–9%), it is likely that FM develops progressively as RA advances. This increased prevalence may be driven by a shared mechanism of chronic pain related to nociceptive system dysfunction.

FM significantly worsens the clinical picture in RA patients: these patients report more intense pain, greater fatigue, worse functional capacity, a higher number of tender joints, and poorer patient global assessments – factors that inflate disease activity scores such as DAS28, CDAI, and SDAI.

FM is also a major contributor to suboptimal responses to biologic DMARDs and Janus kinase inhibitors (JAKi) in RA patients. The coexistence of RA and FM may define a specific phenotype known as non-inflammatory refractory rheumatoid arthritis (NIRRA), distinguished among difficult-to-treat RA variants.

Timely diagnosis of FM is essential for personalizing RA treatment and avoiding unnecessary switching of biologics and JAKi. However, management of RA patients with coexisting FM remains poorly developed. Promising strategies include the use of IL-6 inhibitors and JAKi, which have demonstrated good analgesic potential and the ability to reduce nociceptive dysfunction. FM treatment should also involve antidepressants, anticonvulsants, and non-pharmacological interventions.

This review examines the various types of systemic lupus erythematosus (SLE) course. It discusses the challenges in predicting disease flares and the heterogeneity of SLE progression. Special attention is given to the damage index, which correlates with long-term outcomes and patients’ quality of life.

This literature review addresses the epidemiology, genetic markers, pathogenesis, clinical features, and diagnostic approaches of granulomatosis with polyangiitis and microscopic polyangiitis – both antineutrophil cytoplasmic antibody-associated vasculitides. Particular attention is paid to the role of neutrophil activation and the alternative complement pathway in disease development. The review also includes information on avacopan, an orally administered, selective C5a receptor (C5aR1) inhibitor that blocks the C5a complement component signaling pathway.

These guidelines represent the official 2025 recommendations of the League of Eurasian Rheumatologists (LEAR) for the diagnosis and management of primary osteoarthritis. The recommendations were developed with participation of leading experts in Russia, Kazakhstan, Kyrgyzstan, and Uzbekistan.

The expert council evaluated the appropriateness of using a preparation containing a combination of B-group vitamins in the multimodal treatment of pain associated with osteoarthritis (OA). Theoretical rationale, clinical trial data, and meta-analyses support the consideration of high-dose B vitamin complexes as an effective component of combination therapy for musculoskeletal pain in OA.