Progressive multifocal leukoencephalopathy (PML) is a severe progressive viral disease that affects the central nervous system in patients with immunodeficiency. It may develop as a complication in patients with systemic inflammatory rheumatic diseases (primarily in those with systemic lupus erythematosus), including that during active antirheumatic therapy. The paper presents data on the etiology, epidemiology, and pathogenesis of the disease, characterizes its clinical presentation, highlights main approaches to its diagnosis, and gives current diagnostic criteria. A questionnaire used to monitor neurological status is shown. The paper emphasizes the importance of this monitoring, for early diagnosis and timely cessation of PML treatment with a drug, a potential trigger, are factors that influence prognosis to the utmost degree.

Objective: to estimate the sensitivity and specificity of ASAS (Assessment of Spondyloarthritis International Society) criteria for peripheral spondyloarthritis (SpA) in patients with early psoriatic arthritis (ePsA).

Subjects and methods. Examinations was made in 45 patients (17 men and 28 women) with ePsA meeting the CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria (mean age, 37 years; disease duration, 1 year) and in 20 patients (9 men and 11 women) with signs of peripheral SpA meeting the ESSG (European Spondyloarthropathy Study Group) criteria (mean age, 23 years; disease duration, 2.25 years; control group). The investigators estimated 78/76 tender/swollen joints and enthuses using MASES (Maastricht Ankylosing Spondylitis Enthesitis Score) and assessed the presence of inflammatory spinal pain according to the ASAS criteria, psoriasis, uveitis, inflammatory bowel diseases, genitourinary and/or enteric infections, and a family history of SpA. They also performed X-ray studies of the hand and distal portions of the foot and pelvis and graded sacroilitis using the Kellgren scores. HLA-B27, C-reactive protein, and erythrocyte sedimentation rate were determined. The sensitivity/specificity, likelihood ratios, and clinical value of criteria were calculated.

Results. 41/4 and 31/14 patents with ePsA met/unmet Criteria Sets I and II. The sensitivity/specificity of Sets I and II was 91.1/10% and 68.8/95%, respectively. One patient with ePsA and two patients in the control group did not meet one of the sing sets. The total sensitivity/specificity was 97.8/10%. In the control group, the sensitivity/specificity of Sets I and II was 91.1/100% and 68.8/100%, respectively. For ePsA, the positive likelihood ratio proved to be high for Set II (13.78%) and low for Set I (1.01).

Conclusion. ASAS Criteria Set I for peripheral SpA is of low value in identifying ePsA and Sign Set II shows a high value in diagnosing ePsA as it includes the major clinical manifestations of the disease. Both the ASAS for peripheral SpA and CASPAR criteria may be used for the classification of PsA.

Objective: to estimate the time course of bone mineral density (BMD) changes during 4-year rituximab (RTM) therapy in postmenopausal women with rheumatoid arthritis (RA).

Subjects and methods. Seventy-nine postmenopausal women with a valid diagnosis of RA were followed up. According to the basic therapy option, all the patients were allocated into two groups: 1) 44 patients who received combination therapy with RTM and methotrexate (MT); 2) 35 patients who had MT monotherapy. BMD was estimated by dual-energy X-ray absorptiometry using an Excell XR-46 stationary dualenergy X-ray bone densitometer (Norland, USA).

Results. There was a statistically significant increase in femoral neck BMD and T score as compared to the baseline values in the RTM group after 3 years of follow-up. The MT monotherapy group showed no statistically significant densitometric changes in the femoral neck. The similar positive BMD changes were observed 4 years following RTM and MT therapy.

Conclusion. Following 2 therapy cycles, femoral neck BMD parameters were noted to be stabilized in the patients with RA. After 3 therapy cycles, there was a positive densitometric change that remained by the fourth therapy cycle.

Objective: to assess different treatment regimens for ankylosing spondylitis (AS). The specific features of using topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs) and myorelaxants in outpatient settings were retrospectively analyzed.

Subjects and methods. The investigation enrolled 96 AS patients admitted to the Department of Rheumatology, Saratov Regional Clinical Hospital, in 2010 to 2012, who took nimesulide during the last year (at least three 14-day cycles). The patients' mean age was 42.6±10.9 years; disease duration was 11.9±8.2 years; 83.33% were male. The diagnosis of AS was based on the 1984 modified New York criteria. Physical examination (clinical blood analysis, clinical urinalysis, C-reactive protein, total protein, albumins, urea, creatinine, glucose, bilirubin, serum aspartate aminotransferase and alanine aminotransferase) was made. AS activity was determined using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Axial skeleton mobility and cervical spine rotation were evaluated. Therapy received by the patients at the moment of hospitalization and the attending physicians' recommendations for discharging patients from the hospital were analyzed. Saratov outpatient physicians were interviewed using a questionnaire to specify the aims and procedures of using anti-inflammatory drugs.

Results. The outpatient physicians (n=100) were shown to use three-, two-, and one-component therapy in 53.12, 45, and 2% of the AS patients, respectively. Higher lumbar spine mobility and comparably reduced pain were established in the patients receiving threecomponent therapy (a combination of nimesulide 200 mg/day, tizanidine 4–8 mg/day, and topical NSAIDs) than those who had NSAIDs only.

Systemic vasculitides (SV) are a group of diseases characterized by vessel wall inflammation that leads to ischemic changes in the organs and tissues, which the respective vessels supply blood to; the spectrum of the clinical manifestations of SV depends on the type, size, location of the affected vessels, and on the activity of systemic inflammation. The etiology of the majority of primary vasculitides is unknown. It is assumed that many microorganisms may initiate inflammation of vessels of various sizes, but only some forms of SV (and in some patients) can be clearly related to certain causative and/or trigger factors (drug hypersensitivity, hepatitis B virus, hepatitis C virus, etc.). The paper gives clinical examples of the timely diagnosis and treatment of 2 SV cases in young men working on the railway of the town of Ruzaevka.

Osteoarthritis is (OA) is a chronic slowly progressive inflammatory disease, in the pathogenesis of which a large role is assigned to immune disorders: increased synthesis of proinflammatory cytokines (interleukin 1, tumor necrosis factor-α) that activate catabolic processes not only in cartilaginous tissue, but also in subchondral bone and other joint structures. Nonsteroidal anti-inflammatory drugs are recommended to be used as symptom-modifying agents that block the production of prostaglandins. The choice of slowly symptomatic drugs is rather wide. Diacerein is one of them. The author has evaluated the efficacy and safety of diacerein in the treatment of knee and hip OA over a period of 7 years. She also presents her own experience in using the drug.

The treatment of rheumatic diseases of juxta-articular soft tissues (RDJAST) of the upper extremity (rotator cuff tendinitis, epicondylitis, de Quervain’s syndrome, trigger finger, carpal tunnel syndrome) entails a combination of drug and nondrug therapies. The basic agents that have been proven to be efficacious in this pathology are nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticosteroids (GCs). The paper considers the largest and known studies that are an evidence base for the expediency of using agents, such NSAIDs, local administration of GCs, hyaluronic acid, and plateletrich plasma, as well as different non-drug treatments, in RDJAST. The latter (physiotherapy, exercises, and rehabilitation programs) should be regarded as a necessary component of the therapeutic process in patients with RDJAST-associated chronic pain. Preservation of obvious pain and impaired function despite medical therapy should be regarded as an indication for surgical treatment.

The prevalence of systemic lupus erythematosus (SLE) varies greatly in different regions of the world. The disease is encountered in different age groups; however it is most common in young and adolescent women (its peak incidence is in the range of 15–25 years). Familial SLE cases are known. The course of SLE in pregnant women is noted to have features due to an increased risk for complications and to pharmacotherapeutic peculiarities. Risk factors for poor pregnancy outcomes, such as high disease activity at the time of conception, active lupus nephritis, and the presence of antiphospholipid antibodies (APA), are identified in patients with SLE. The paper presents antenatal fetal death predictors: proteinuria, thrombocytopenia, APA, and hypertension. When SLE is concurrent with secondary antiphospholipid syndrome (APS), the risk of poor pregnancy outcome is 30%. Management tactics for pregnant women with APS and a dosage regimen are shown to largely depend on history data (the presence (absence) of nonplacental thromboses, the number of spontaneous abortions, prior therapy, etc.). There are four patient groups: 1) patients who have only anticardiolipin antibodies without previous pregnancy or one episode of unexplained abortion at less than 10 weeks’ gestation with no history of thrombosis; 2) those who have APS with no history of nonplacental thrombosis and have anticardiolipin antibodies and a history of two or more unexplained spontaneous abortions at less than 10 weeks’ gestation; 3) those who have APS and a history of nonplacental thromboses (who have taken warfarin prior to pregnancy); 4) those in whom standard therapy is ineffective during their next pregnancy. The paper presents therapy options for each patient group.

It is concluded that effective therapeutic strategy for SLE, including that in pregnant women, implies patient monitoring to long maintain remission (low disease activity).

Tumor necrosis factor-α (TNF-α) holds a central position in the pathogenesis of autoimmune inflammatory diseases of the locomotor apparatus. A separate class of drugs, namely, TNF-α inhibitors, that are effective against multicomponent diseases, such as psoriatic arthritis (PsA), is now available to physicians. The paper reviews the results of clinical trials of the TNF-α inhibitor golimumab, a human TNF-α monoclonal antibody. Golimumab exerts a positive effect on all manifestations of PsA: arthritis, psoriatic skin and nail lesions, dactylitis, enthesitis, and quality of life. The drug is noted for its convenient route of administration – its standard dose is 50 mg injected subcutaneously once a month and for its low molecular immunogenicity. Recent data suggest that golimumab is an effective drug with a safety profile similar to that of the entire class of TNF-α inhibitors.

The necessity to achieve clinical remission or low disease activity in every patient with rheumatoid arthritis highlights the importance of combination therapy with methotrexate and biological agents for treatment of resistant to conventional disease-modifying anti-rheumatic drugs patients. Modern requirements mean not only the achievement of results but also long-term maintaining of success. The possibility to get stable results of treatment is determined by many factors such as: clinical efficacy, safety, low immunogenicity, persistence on therapy and the economic feasibility. Analysis of published data for last 5 years leads to the conclusion that etanercept has an optimal combination of these parameters among inhibitors of tumor necrosis factor alpha.

Pain control is a fundamental task in the management of patients with locomotor diseases. Analgesic therapy holds the most important position in treating common diseases, such as osteoarthritis, nonspecific spinal pain, and rheumatic diseases of juxtaarticular soft tissues. Pain development and chronization in these conditions are determined by a uniform pathogenetic mechanism, the key component of which should be considered to be inflammation. This necessitates the use of antiinflammatory drugs, first of all, nonsteroidal antiinflammatory drugs (NSAIDs). When the latter are used, the risk of their adverse reactions should be necessarily taken into account and the choice of a specific drug should be based on an efficacy-safety ratio. Aceclofenac may be legally regarded as one of the most balanced NSAIDs in this respect. The paper reviews the data available in the literature on the use of this drug, including the largest clinical and epidemiological studies.

The given description of the 2014 new international guidelines prepared by the International Panel of Rheumatologists in the 3e Initiative reflects the diagnosis, treatment and prevention of gout, which are adapted for clinical practice.

The Meeting of the Expert Council considered in detail the key aspects associated with the possible development of adverse reactions during therapy with tofacitinib (TOFA). Active discussion gave rise to a resolution that summarized the main facts concerning the safety of TOFA and gave practical recommendations for the screening and monitoring of infections, cardiovascular diseases and other key areas requiring that exclusive control should be exercised during this therapy. TOFA is the first drug from a new group of immunomodifying and anti-inflammatory drugs, intracellular kinase inhibitors. As of now, it is the only drug that belongs to a class of the so-called small molecules, which is approved for the treatment of rheumatoid arthritis in the Russian Federation and a number of other countries. TOFA is a low molecular weight drug for oral administration; however, its unique mechanism of action brings it close to that of biological agents. A broad spectrum of biological effects of TOFA and its potential effect on a number of important physiological processes demand for special attention to the safety of its therapy.

The paper debates over the classification of spondyloarthritis (SpA). The paper «Diagnosis of spondyloarthritis: Should we need new criteria?» published in the journal «Sovremennaya Revmatologiya=Modern Rheumatology Journal» 2015. No. 1 has given occasion to discussion. Of dispute are the paper’s conclusions: «At present most patients with SpA meet ≥2 classification criteria, which gives the chance to state ≥2 nosological entities in the same patient. This demonstrates the need to elaborate diagnostic criteria that can make a clear distinction between different forms of SpA».

The author of this publication touches upon its two interrelated disputable aspects: 1) the specific features of the criteria, which have led to this conclusion and 2) the classification peculiarities, i.e. whether SpA is a single clinical polymorphic disease or a group of a few diseases having a certain common sign.

The rheumatoid arthritis (RA) session was held in Sochi on April 25, 2015, within the framework of the National Rheumatology Summit. Leading Russian and foreign experts discussed the general provisions of the 2013 European League Against Rheumatism (EILAR) guidelines and the Association of Rheumatologists of Russia (ARR) ones for the management of RA, considered optimal usage periods for biological agents to achieve the goals of treatment for early and long-term RA, by using adalimumab (ADA) as an example, and analyzed the results of trials of the efficiency and safety of combined therapy with ADA and methotrexate. Particular emphasis was placed on the results of introducing the treatto-target concept into Russian clinical practice and on those of monitoring RA patients.