The article discusses current concepts of Sjögren’s disease as an independent multisystem autoimmune disorder with a wide spectrum of organ manifestations and a high risk of lymphoproliferative complications. Special attention is given to new data on pathogenetic mechanisms based on B-cell hyperactivity. The most advanced approaches to monitoring and treatment are discussed, including the implementation of activity indices and the prospects of targeted therapy.

The second part of the lecture is devoted to the issues of differential diagnosis of certain immune-inflammatory rheumatic diseases and syndromes directly associated with HIV infection, with an emphasis on immune reconstitution inflammatory syndrome during antiretroviral therapy, the differential diagnosis of Sjögren’s syndrome and diffuse interstitial lymphocytic syndrome, and the manifestation of systemic lupus erythematosus in HIV infection. Modern classification of muscle involvement and issues of vasculitis pathogenesis in HIV-infected patients are considered.

The article presents the new 2025 guidelines of the American College of Rheumatology (ACR) for the treatment of systemic lupus erythematosus (SLE) without renal involvement, with commentary from leading SLE experts — staff members of the V.A. Nasonova Research Institute of Rheumatology.

Since the publication in 2016 of the EULAR statements on the use of antirheumatic drugs before conception, during pregnancy, and breastfeeding, results of several studies on the safety of these drugs in these periods have appeared, allowing a substantial update of the previous version. New data make it possible to increase the level of evidence for some medications. All recommendations are supported by expert consensus with a high degree of agreement. The updated version includes recommendations on the use of antirheumatic drugs in women and men planning conception, as well as during pregnancy and lactation.

Objective: to investigate the association of pro-inflammatory cytokines, including interleukin (IL)-6, tumor necrosis factor α (TNFα), IL-1 receptor antagonist (IL-1Ra), with subclinical left ventricular (LV) dysfunction in patients with rheumatoid arthritis (RA).

Material and methods. The study included 61 patients with RA who met the 2010 ACR/EULAR (American College of Rheumatology / European Alliance of Associations for Rheumatology) criteria. In this group, 80% were women, mean age was 47.8±10.1 years, and the median disease duration before initiation of biologics was 120 [54; 165] months. All patients underwent determination of serum N-terminal pro-brain natriuretic peptide (NT-proBNP), IL-6, TNFα, IL-1Ra levels, and echocardiography with assessment of global longitudinal myocardial deformation (GLSLV) of the LV using speckle-tracking.

Results and discussion. In patients with RA, IL-6 and TNFα levels were significantly higher than in controls. In RA patients with subclinical myocardial dysfunction, IL-6 levels were significantly higher than in patients with preserved myocardial function (median 14.7 [0.76; 38.5] and 7.8 [0.11; 17.5] pg/ml, respectively; p<0.05). TNFα and IL-1Ra levels did not differ significantly between these groups. RA patients were divided into four groups. Group 1 included patients with elevation of all three cytokines (n=9), group 2 – of two cytokines (n=19), group 3 – of one cytokine (n=23), and group 4 (n=10) had normal cytokine levels. ESR, DAS28 (Disease Activity Score 28), and CRP levels in groups 1–3 were higher than in group 4. All groups differed significantly in ejection fraction (EF) and LV lateral mitral annular velocity (E’). GLSLV was significantly lower in group 1 than in group 4. IL-6 level correlated with GLSLV (r=-0.4); IL-1Ra level– with EF (r=-0.5), LV E’ (r=-0.4), and the ratio of early transmitral flow velocity (E)/E’ (r=0.3); TNFα level – with LV E’ (r=-0.3), p<0.05 for all comparisons.

Conclusion. In RA patients with myocardial dysfunction, IL-6 levels are significantly elevated. Simultaneous elevation of IL-6, IL-1Ra, and TNFα leads to more pronounced impairment of systolic and diastolic myocardial function. Inflammation in RA contributes to the deterioration of cardiac myocardial function.

Objective: to investigate indicators of inflammatory activity and biochemical markers of bone metabolism as factors influencing bone microarchitecture, assessed by the trabecular bone index (TBI), in women with rheumatoid arthritis (RA).

Material and methods. A cross-sectional study included 124 women with verified RA (mean age 60.3±10.0 years). A survey using a proprietary questionnaire, laboratory testing, and lumbar spine (L1–IV) X-ray densitometry with determination of TBI were performed.

Results and discussion. Degraded bone microarchitecture was found in 33.9%, partially degraded in 21.8%, and normal in 44.3% of women with RA. In univariate regression analysis, age (p<0.001), duration of postmenopause (p=0.035), levels of uric acid (UA; p=0.023), alkaline phosphatase (ALP; p=0.021), anti-cyclic citrullinated peptide antibodies (anti-CCP; p=0.037), and phosphorus (=0.23; p=0.011) correlated with TBI values.

Conclusion. Normal bone microarchitecture was found in only 44.3% of women with RA. TBI was negatively associated with age, duration of postmenopause, levels of UA, ALP, and anti-CCP, and positively with phosphorus level. No correlation was observed between TBI values and indicators of RA inflammatory activity.

Objective: to assess the frequency of thromboangiitis obliterans (TAO) vascular lesions and its association with clinical and laboratory manifestations in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).

Material and methods. The study included 172 patients (30 men and 142 women): 22 (13%) with isolated “primary” APS (pAPS), 66 (38%) with SLE, and 84 (49%) with SLE + APS. The median age was 36 [30; 46] years. Disease duration in the SLE + APS group was longer than in the pAPS and SLE groups (median 17 [9; 21], 5 [2; 13], and 7 [3; 12] years, respectively; p<0.05). All patients were hospitalized at the V.A. Nasonova Research Institute of Rheumatology due to exacerbation of the underlying disease and underwent a comprehensive examination.

Results and discussion. Vascular lesions of the TAO type were recorded in 17 (10%) of 172 patients: 1 with pAPS, 13 with SLE + APS, and 3 with SLE. The development of TAO in patients with SLE + APS was influenced by the following factors: dyslipidemia (odds ratio, OR 10.74; 95% confidence interval, CI 3.29–34.99; p<0.01), arterial hypertension (OR 7.19; 95% CI 1.98–26.07; p<0.01), and Raynaud’s syndrome (OR 7.72; 95% CI 2.61–22.82; p<0.01). As a result of multivariate analysis, a prognostic model was obtained, according to which the number of aseptic bone necroses, the number of lower leg ulcers over the entire disease course, the type of thrombosis, APS duration, disease onset with APS manifestations, livedo reticularis, elevated levels of IgG antibodies to cardiolipin, to β₂-glycoprotein 1, total cholesterol, C-reactive protein (CRP), and an increase in leukocyte count are associated with a higher probability of TAO development in patients with SLE and/or APS.

Conclusion. Risk factors for the development of TAO in patients with SLE and APS are aseptic bone necroses, trophic ulcers of the lower legs, APS duration, livedo reticularis, elevated levels of IgG antibodies to cardiolipin, to β₂-glycoprotein 1, total cholesterol, CRP, and an increased leukocyte count.

Esophageal involvement is one of the most frequent visceral manifestations of systemic sclerosis (SSc), however, its association with the course of the disease has been insufficiently studied. Endoscopy is considered the most accessible instrumental method for examining the esophagogastroduodenal zone, and in combination with clinical symptoms forms the basis for diagnosing esophageal diseases.

Objective: to investigate the frequency of clinical and endoscopic signs of esophageal disorders (ED) and their association with clinical manifestations of SSc.

Material and methods. A total of 81 patients with SSc hospitalized at the Chelyabinsk Regional Clinical Hospital from December 2019 to September 2024 were examined.

Results and discussion. In 40 (49.4%) patients, symptoms characteristic of ED were present: dysphagia (n=38, 46.9%) and heartburn (n=14, 17.3%). During esophagogastroduodenoscopy, erosive esophagitis (EE) was detected in 13 (16%) patients. In 5 (6.2%) cases, esophagitis grade B or higher was identified, and in 2 (2.5%) – grade D. Patients with EE more frequently had digital ulcers and scars, and treatment included sildenafil and cyclophosphamide (CYP) (p<0.05). The frequency of esophageal erosions was 4.12 times higher in the presence of digital ulcers (95% confidence interval, CI 1.20–14.13; p<0.05) and 9.48 times higher with CYP use (95% CI 1.81–49.45). The frequency of interstitial lung disease (ILD) did not depend on the presence of EE, but increased 4.33 times in the presence of esophageal atony according to radiography (95% CI 1.24–15.2).

Conclusion. Patients with SSc report dysphagia or heartburn in half of the cases. EE is associated with more pronounced microcirculatory disturbances and treatment with CYP. ILD occurred more frequently when radiologic signs of esophageal atony were present.

Objective: to assess the impact of extra-articular manifestations (EAM) on the achievement of clinical effect of seniprutug (SENI) in patients with active radiographic axial spondyloarthritis (r-axSpA) during 48 weeks of therapy.

Material and methods. A post hoc analysis of results from an international multicenter randomized placebo-controlled phase II clinical trial (CT) BCD-180-2/ELEFTA (ClinicalTrials.gov NCT05445076) involving HLA-B27 positive biologic-naive patients with active r-axSpA was conducted. The main results of the CT ELEFTA on the clinical efficacy and safety of SENI over 48 weeks of therapy have been previously published.

A comparative post hoc analysis of SENI efficacy was conducted at week 48 in subgroups of patients with presence (n=48) and absence (n=212) of EAM, who received SENI at doses of 5 mg/kg or 7 mg/kg or Placebo/SENI 5 mg/kg. Efficacy parameters included dynamics in the ASDAS, BASFI, as well as total back pain intensity and night back pain scores on a numerical rating scale (NRS), and C-reactive protein (CRP) levels. Additionally, the frequency of achieving ASAS40, ASAS5/6 responses, ASDAS clinically important improvement (ASDAS-CII), and low disease activity or inactive disease according to ASDAS was analyzed.

The assessment of treatment tolerability included analysis of the frequency of worsening of existing EAM and the occurrence of cases of EAM de novo.

Results and discussion. In both subgroups of patients with and without EAM of axSpA we observed decrease of CRP level with improvement of the disease activity according to the ASDAS index and improvement of functional impairments according to the BASFI index, as well as achievement of ASAS40 and ASAS5/6 responses and a reduction in of the total back pain and night back pain according to the NRS. Statistically significant superiority over placebo was demonstrated in the SENI subgroup without EAM at all efficacy parameters and at several assessment points in the SENI subgroup with EAM already in the first weeks of therapy and up to week 24. Further, the achieved clinical effect was maintained, up to week 48, in all SENI subgroups regardless of the presence of EAM, while in placebo subgroups, an increase in effect was observed due to switching to active drug therapy at week 24. In the SENI subgroup with EAM, a numerically more pronounced clinical effect was noted at the beginning of therapy without statistically significant differences compared to the SENI subgroup without EAM.

In all studied subgroups, a favorable tolerability profile of SENI therapy was demonstrated. No EAM de novo was registered.

Conclusion. SENI demonstrates significant stable clinical efficacy and good tolerability over 48 weeks of active r-axSpA treatment regardless of the presence or absence of EAM, with a trend to faster and more pronounced clinical effect in the first weeks of therapy in patients who had EAM.

Objective: to evaluate the effects of the novel pharmaconutraceutical Revocca on the clinical manifestations of osteoarthritis (OA).

Material and methods. A 3-month prospective study included 50 women aged 40–75 years (mean age 58.3±10.1 years) with a confirmed diagnosis of knee OA according to ACR criteria, Kellgren–Lawrence grade II–III, with pain on walking ≥40 mm on a visual analogue scale (VAS), who provided written informed consent. The median OA duration was 5 [3; 8] years.

A metabolic phenotype of OA was present in 22% of patients, an inflammatory phenotype in 10%, an osteoporotic phenotype in 12%, a mixed phenotype in 26%, while in 30% the phenotype could not be determined.

Patients took 2 capsules of the pharmaconutraceutical once daily throughout the observation period. All patients were allowed to use nonsteroidal anti-inflammatory drugs (NSAIDs) “as needed.”

Three physician visits (V) were scheduled during the study. Treatment efficacy was assessed by the dynamics of pain intensity in the target knee joint on walking (VAS), WOMAC index, KOOS scale, and EQ-5D questionnaire scores. Additional assessments included the patient’s VAS global health assessment, physician’s and patient’s assessments of treatment efficacy, and the need for NSAIDs.

Results and discussion. After 1 month of therapy, a statistically significant positive change was observed in all evaluated parameters (p<0.05), except for stiffness on the WOMAC scale. However, by month 3 a substantial reduction in stiffness was recorded, while all other parameters continued to improve. By V-3, a good treatment response (≥50% pain reduction from baseline) was achieved in 60% of patients, and pain intensity ≤40 mm on VAS in the affected joint was documented in 88%. A reduced need for NSAIDs was noted: the total number of cases of dose reduction or NSAID discontinuation reached 40% by V-2 and 48% by V-3.

Conclusion. The study results indicate a rapid and pronounced clinical effect of Revocca in patients with various OA phenotypes.

Structures resembling “rice bodies” (RB) may be found in patients with rheumatoid arthritis (RA), systemic lupus erythematosus, psoriatic arthritis, and tuberculous tenosynovitis. The joint cavity is a typical site of RB localization. Although the presence of RB may create diagnostic difficulties in patients with rheumatic diseases, they are rarely mentioned in the literature. Various etiological causes of this disorder have been proposed. Magnetic resonance imaging is the main non-invasive method for detecting RB. Pathology examination is used to verify the changes. The article presents a clinical case of RB detection in the cavity of the left shoulder joint in an elderly woman with a long history of RA and comorbidities, and describes the diagnostic methods and treatment approach.

At the first consultation of a patient with suspected rheumatic disease (RD), the physician must form a diagnostic concept, determine the scope of diagnostic evaluation, decide on the need for further routing of the patient, consider the treatment strategy, and make initial prescriptions aimed at controlling the main and most burdensome symptoms (most likely musculoskeletal pain). One of the central elements of the consultation should be a thorough analysis of complaints and medical history, as well as a complete physical examination, allowing the identification of many key symptoms necessary for the differential diagnosis of RD. Considering the time constraints, the physician’s actions should be consistent and deliberate. Creating a favorable psychological environment is of great importance, achieved by demonstrating confidence, empathy, and avoiding “forbidden phrases” that may upset the patient and even provoke conflict.

In most cases, the consultation should end with recommendations that reduce the patient’s suffering and improve quality of life. This primarily concerns the prescription of analgesics. At the first visit, it is advisable to recommend well-known medications with proven therapeutic potential and a favorable safety profile. Among nonsteroidal anti-inflammatory drugs, such an agent is aceclofenac; among centrally acting muscle relaxants — tolperisone hydrochloride.

In 2025, new clinical guidelines on gout – one of the most common rheumatic diseases – were published. This article discusses the main principles of the practical application of the key component of successful gout management: urate-lowering therapy (ULT). Special attention is given to the indications for initiating ULT, the timing of its initiation and duration, and the principles for selecting the optimal target serum uric acid (UA) level. The most rational regimens for prescribing allopurinol and febuxostat are examined, taking into account, in accordance with the guidelines, the clinical manifestations of gout and the presence of comorbidities. Other medicinal agents that affect serum UA levels are also presented.

Clinical guidelines are a key tool in practical medicine; their primary purpose is to improve the effectiveness of treatment for somatic diseases. The guidelines systematize research data concerning various therapeutic options and regimens, as well as the efficacy and safety of medicinal products, which potentially reduces the risk of complications and improves disease outcomes when accumulated experience is applied rationally. In 2025, the clinical guidelines for idiopathic gout were updated. This article discusses the main approaches to prescribing symptomatic therapy aimed both at alleviating acute arthritis attacks and at preventing subsequent gout flares during the initiation of urate-lowering therapy.

Rheumatoid arthritis (RA) remains associated with a higher risk of mortality compared to the general population. The prognosis in RA is determined not so much by chronic arthritis as by comorbid diseases. The article presents data on the prevalence and structure of comorbid conditions, as well as the causes of death in patients with RA in different countries. Differences in comorbidity profiles and mortality among RA patients in European, Asian, and African countries are shown.

Autoinflammatory diseases (AIDs) represent a heterogeneous group of conditions pathogenetically associated with dysregulation of innate immunity and clinically characterized by recurrent episodes of sterile inflammation in affected organs in the absence of infection, allergy, and high titers of circulating autoantibodies or autoreactive T cells. The overwhelming majority of monogenic AIDs (mAIDs) are accompanied by skin rashes, the type of which is determined by the specific disease and, to some extent, by differing pathogenetic mechanisms.

The first part of the article presents the cutaneous characteristics of the most common mAIDs: Familial Mediterranean fever (FMF), cryopyrinassociated periodic syndromes (CAPS), tumor necrosis factor receptor-associated periodic syndrome (TRAPS), periodic syndrome with hyperimmunoglobulinemia D / mevalonate kinase deficiency (HIDS/MKD). Skin involvement in these diseases reflects systemic inflammation associated with hyperproduction of the key pro-inflammatory cytokine interleukin (IL)-1β. In other AIDs, symptoms mainly depend on increased levels of cytokines such as IL-18, IL-36, etc. (NLRC4-associated autoinflammatory disease; deficiency of the IL-36 receptor antagonist – DITRA), as well as activation of interferon signaling pathways (interferonopathies). Different pathogenetic mechanisms determine the diversity of clinical phenotypes, including cutaneous manifestations. Knowledge of these features helps establishing a correct diagnosis, obtaining genetic confirmation (without which accurate identification of these rare conditions is impossible today) and selecting appropriate therapy. Pathological examination plays a special auxiliary role and should be used in diagnostically challenging situations.

Colchicine – an alkaloid isolated from the corms of Colchicum autumnale – is a potent pharmacological agent used in the treatment of various conditions. Its clinical efficacy, confirmed by numerous studies, raises no doubts within the scientific community. Nevertheless, despite the proven therapeutic properties of colchicine, its safety remains surrounded by myths and prejudices. In this work, we attempted to refute these myths, relying on modern scientific data and methodological approaches.

The impact of meat products and alcohol on uric acid (UA) levels is well known, whereas the effect of other food products has been studied insufficiently. Current studies indicate that the consumption of non-meat products, including dairy products, cereals, legumes, and vegetables, may lead both to a decrease in UA levels and to its accumulation. For example, dairy products may promote UA excretion, whereas some plant-based foods and beverages, due to their high purine and fructose content, increase the risk of gout flares.

This paper considers current data on the influence of various non-meat products on purine metabolism and their role in the development and prevention of gout.