Significant progress in treating immunoinflammatory rheumatic diseases (RD) is related to the design of a novel family of drugs, genetically engineered (GE) drugs. Molecular and cellular biomarkers (antibodies, indicators of acute inflammation, cytokines, chemokines, growth factors, endothelial activation markers, immunoglobulins, cryoglobulins, T- and B-cell subpopulations, products of bone and cartilage metabolism, genetic and metabolic markers) that allow one to conduct immunological monitoring and prediction of the effectiveness of RD therapy using tumor necrosis factor α inhibitors (infliximab, adalimumab, golimumab, etanercept), anti-B-cell drugs (rituximab, belimumab), interleukin-6 receptor antagonist (tocilizumab), and T-cell costimulation blocker (abatacept) have been detected in blood, synovial fluid, urine, and bioptates of the affected tissues. In addition to the conventional uniplex immunodiagnostics techniques, multiplex analysis of marker, which is based on genetic, transcriptomic and proteomic technologies using DNA and protein microarrays, polymerase chain reaction, and flow cytometry, is becoming increasingly widespread. The search for and validation of immunological predictors of the effective response to GE drug therapy make it possible to optimize and reduce the cost of therapy using these drugs in future.

The problems of acute rheumatic fever (ARF) and chronic rheumatic heart disease (CRHD) are discussed. Carditis, polyarthritis, erythema annulare, subcutaneous nodules, and chorea minor are the main clinical manifestations of ARF caused by β-hemolytic streptococcus A. Cardiac failures emerge in 60–65% of patients after the first ARF episode. Repeated ARF attacks promote CRHD.
The aim of the study is to evaluate the prevalence of rheumatic heart disease in different age groups in the regions of Russian Federation in 2011–2012.
Materials and Methods. Analysis of the Ministry of Healthcare of the Russian Federation reports on population morbidity in 2011–2012 (Form N12).
Results. The highest ARF prevalence was observed in 15–17-year-old teenagers, while the lowest, in adults over 18-year-old. The lowest CRHD figures were registered in juniors, while the highest ones, in adults. No ARF cases in 0–14-year-old children were registered in 31 entities of the Russian Federation; single cases, in 17 entities; no ARF cases in 15–17-year-old teenagers was registered in 37 entities, and 1–2 ARF cases were registered in 23 entities. Only in 10 entities, no ARF cases were registered in adults, and single cases were registered in 22 entities. Extremely unfavorable situations were found in the Chechen Republic (140 ARF cases in 0–14-year-old children) and in the Dagestan Republic (140 cases). High morbidity among 15–17-year-old teenagers was registered in tje Kaliningrad region (83 cases) and the Chechen Republic (100). ARF cases in adults were most frequent in St. Petersburg (124 cases), the Chechen Republic (154), and the Moscow region (161).
The article lists the ARF and CRHD preventive measures.

Objective. To examine the relationships between measures of bone mineral density (BMD), coronary atherosclerosis, and coronary artery calcification among men with ischemic heart disease (IHD).
Materials and Methods. Seventy-four men with angiographically documented IHD were assessed. BMD was measured by dual-energy absorptiometry and defining the T-score, radiopaque selective coronary angiography with the analysis of severity of coronary artery lesions using the SYNTAX score, evaluating the coronary artery calcium score according to the Agatston method. Depending on the T-score, patients were divided into 2 groups: group I – patients with osteopenic syndrome (53 patients) aged 59 (52;68) years; group II – patients with normal BMD (21 patients) aged 58 (54;66 ) years.
Results. Osteopenic syndrome among men with IHD was revealed in 71.6% of cases. Severe coronary lesions predominated among patients with osteopenic syndrome (p=0.041). Single-vessel coronary lesions in the group with osteopenic syndrome was detected less frequently than in the normal BMD (p=0.023) group. Calcium score values significantly correlated with the severity of coronary lesions according to the Syntax scale (r=0,53; p=0.002).
Conclusion. Reduced bone mineral density among men is associated with hemodynamically significant lesion and correlates with the severity of coronary atherosclerosis, which confirms the likelihood of common pathogenesis of osteopenic syndrome and coronary artery atherosclerosis.

We report the data of the history of describing osteopetrosis (marble bone disease), its clinical features, diagnosis, and possible therapy approaches. Our own clinical case is presented.

Rheumatoid arthritis (RA) is a progressive disease, resulting in joint deformation and development of severe functional disorders. Meanwhile, RA patients frequently have systemic inflammatory disorders of internal organs, which may significantly worsen quality of life, labor capacity, and be a factor determining the prognosis. Idiopathic interstitial pneumonia is of particular interest. This disease is characterized by unfavorable prognosis due to progressive fibrous rearrangement of the lung. We report a clinical case of RA with signs of interstitial lung disease.

Idiopathic inflammatory myopathies (IIM) are rare disorders characterized by inflammatory lesions in skeletal muscles. These diseases include polymyositis (PM), dermatomyositis (DM), and inclusion body myositis, which exhibit clinicoimmunological heterogeneity and give different response to therapy. The most frequent manifestation in PM/DM patients is respiratory system dysfunction. The developing respiratory disorders are varied and may outpace the presentation of muscle pathology.

The Problem of effective treatment of rheumatoid arthritis (RA) has not been solved yet. In patients with an inadequate response to the synthetic disease-modifying antirheumatic drugs (DMARDs), TNF inhibitors and other genetically engineered (GE) drugs may give an incomplete effect or be totally ineffective in 20–40% of cases. The search for new therapeutic options is very active in many directions, including modulation of intracellular signaling pathways. The most impressive clinical results in RA patients have been achieved for Janus kinase (JAK) inhibitor, tofacitinib, – Tofa (CP-690,550), a low molecular weight drug for oral administration. Unlike the conventional synthetic DMARD, Tofa belongs to targeted therapy drugs; its pharmacological effects largely resemble those of GE drugs (blockade of the biological effects of cytokines). In particular, some features of its mechanism of action (e.g., interleukin 6 inhibition) make it similar to tocilizumab. In all trials, Tofa proved to exhibit high clinical efficacy and satisfactory safety. Tofa was shown to be significantly more effective than methotrexate and placebo (in monotherapy, as well as in combination with DMARDs) in RA patients with an inadequate response to standard DMARDs and TNFa inhibitors (regarding response to treatment, individual parameters of disease activity, achievement of low disease activity and remission, functional impairment). Furthermore, Tofa can inhibit joint damage progression.

The published data on efficiency of intravenous immunoglobulin (IVIG) in patients with autoimmune rheumatic diseases (RD) are analyzed. IVIG is the drug of choice in patients with Kawasaki disease, idiopathic thrombocytopenic purpura, dermatomyositis, etc. It is reasonable to use IVIG in RD patients with immune deficiency, infectious complications, ineffectiveness of glucocorticoid and cytostatic treatment in patients with developing autoimmune cytopenia, central nervous system dysfunction, and vasculitis. In patients with antiphospholipid syndrome, IVIG can be effective in case of the risk of miscarriage and ineffective anticoagulant therapy.

A review of literature focused on Behcet's disease (BD) is presented. BD is systemic vasculitis of unknown etiology affecting multiple organs. BD is endemic in the countries along the Eastern Mediterranean coast and the areas of Central and East Asia. We report the data on BD prevalence in different regions and the effect of population migration on BD incidence rate. Patients were found to be younger at the onset of the disease in Arab countries, Turkey, and Israel (19.9; 25.6; and 26 years, respectively) than those in East Asia countries (31.7 years). We summarized the data attesting to the genetic susceptibility in BD patients: HLA B51-positive individuals, family aggregation observed when studying twins, etc. The clinical polymorphism in BD patients was shown to depend on their region of residence and ethnicity. The data of a series of large cohort studies are reported; the frequencies of the international criteria of BD in the US and Japanese patients are compared in these studies. The question regarding the need for cross-sectional population-based and case-control studies using the standard criteria and clear definition of ethnicity is brought up in some publications.

Treatment of rheumatoid arthritis (RA) patients is based on conventional background therapy. This therapy remains the method of choice for patients who had not received basic anti-inflammatory drugs (BAIDs) and is regarded as an obligatory component of combination therapy. The choice of synthetic BAIDs is relatively small; leflunomide (LEF) is now one of the most promising BAIDs. The clinical trials of LEF in RA patients were started in the mid-1990s. LEF has subsequently been widely used in practical healthcare and proved to be one of the most effective drugs in its family. The international and national recommendations for RA treatment regard it as one of the main components of comprehensive treatment, which can be prescribed at any stage of the disease either as the only BAID or combined with other antirheumatic drugs, including synthetic BAIDs and genetically engineered drugs.

Non-steroid anti-inflammatory drugs (NSAID) were and still remain the main means for arresting acute and controlling chronic pains in therapeutic practice. However, serious complications that may be caused by these drugs essentially limit their application. Therapists need distinct and reasonable guidelines on NSAID prescription depending on presence of a comorbid pathology and risk factors associated with the gastrointestinal tract and cardiovascular system. World renowned experts have been actively studying this problem. The main aspects of NSAID efficiency and safety are discussed in this study; the risk factors are ranked according to their significance; and an algorithm of reasonable drug prescription, including prevention of potential complications, is proposed.

A new convenient dosage form of aceclofenac (sashet bags) has recently been launched on the Russian market. The powder in a single sashet bag weighs 3 g, which corresponds to 100 mg of the active ingredient per tablet. A prospective study (including evaluation of the effectiveness and safety of the sashet form of aceclofenac in real-life clinical practice) was carried out in 40 outpatients with osteoarthrosis (OA) of the knee and hip joints during 2 weeks. A clear pain relief by 25% vs the beginning of therapy was observed; joint stiffness decreased by 34%; joint function improved by 17%; and the total WOMAC score decreased by 18% by the end of the therapy (262.7±127.7 vs 198.5±111.6; 88.5±42.21
vs 57.7±32.6; 789.9±307.2 vs 650.6±242.6 and 1087.7±369.3 vs 886.4±326.0, p<0.05, respectively, in all cases). The results of our surveillance study in real-life clinical practice have shown that sashet aceclofenac rapidly relieves pain and reduces joint stiffness, thus improving the functional condition of joints. Adverse effects related to the gastrointestinal tract were observed in only one (2.5%) patient when using sashet aceclofenac. The drug in this dosage form can be recommended as an effective and safe agent, especially for patients who typically receive non-steroidal anti-inflammatory drugs in liquid forms.

A comprehensive program for continuing professional education of rheumatologists «Education throughout Life» was elaborated in 2013 under the auspices of the All-Russian public organization «Russian Association of Rheumatologists» (RAR) and V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences. The program includes implementation of additional forms of educational activity and elaboration of new learning models based on modern telecommunication information technologies. Personified analysis of the acquired knowledge and skills and continuity of the learning process (including the distance education methods) are the mandatory conditions to fulfil the program. Each physician has to earn at least 50 credits annually (a total of 250 credits throughout the 5-year course). The proportion between the remote and resident classes is set depending on the curriculum of the basic cycles for postgraduate education in rheumatology. Under this program, the RAR participates more actively in elaboration and certification of the programs for professional education in rheumatology, as well as other types of educational activity.

Review of the USA, Argentina, Australia, Japan, and European Union registries is presented. The similarities and differences between the registries in terms of populations of rheumatoid arthritis patients and the target goals are studied

The article describes the All-Russian Registry of Rheumatoid Arthritis (RA) Patients launched in 2011Р2012 as an Internet-based project. The Registry aims at updating the record system of RA patients and providing reliable information on real clinical practice to improve healthcare. The aims, structure, and software of the Registry, as well as its interrelations with other registries, are described. A scheme of the interplay between healthcare facilities and the Russian Association of Rheumatologists during their work with the All-Russian Registry of Rheumatoid Arthritis Patients is proposed.