The paper presents the 50th history of orthopedic rheumatology at the V.A. Nasonova Research Institute of Rheumatology. The author was one of the founders of the Department of Orthopedic Rheumatology, V.A. Nasonova Research Institute of Rheumatology, which started out at the department of internal medicine of a city hospital with two beds, being increased up to a 30-bed department with an operational unit and three surgical suites, a dressing ward, a plastering room, and exercise therapy hall. The level of orthopedic rheumatologic surgical care received by the Institute's patients completely corresponds to that in Europe's leading specialized clinics.

It is suggested that interleukin (IL)-1β inhibition may promote a reduction in the risk of cardiovascular diseases; however, the mechanism of this impact has not been adequately investigated.

Objective: to evaluate the impact of canakinumab therapy on the structural and functional properties of the vascular bed and the stiffness of the vessel wall.

Patients and methods. An open-labeled prospective study was conducted in 20 patients with chronic tophaceous gout at the V.A. Nasonova Research Institute of Rheumatology. Among the patients, there were 17 (85%) men and 3 (15%) women. All the patents received a single subcutaneous injection of canakinumab 150 mg. Estimation of high-sensitivity C-reactive protein (hs-CRP) and IL-6 levels, 24-hour blood pressure (BP) monitoring, duplex scanning of the carotid arteries (intimamedia thickness (IMT)), and determination of central artery stiffness (aortic pulse wave velocity (APWV), m/sec) were done before and 14 and 120 days after drug administration; the level of hs-CRP was quantitatively measured using a high-sensitivity immunoturbidimetric assay and the concentration of IL-6 was determined by xMAP technology (Human Grp I Cytokine 27-plex panel on a BioPlex-200 analyzer (Bio-Rad, USA). Antihypertensive lipidlowering therapy was not changed during the investigation. Statistical analysis was carried out using a package of applied Statistica 10.0 programs (StatSoft/Inc., USA).

Results. Examination of the common carotid artery indicated that the median IMT that was 0.83 [0.71; 0.94] mm at baseline decreased to 0.74 [0.69; 0.84] mm by the end of the investigation (p = 0.022). The median APWV that was 14.12 [10; 17] m/sec at baseline dropped to 13.1 [11; 14] by the end of the investigation, but statistically insignificantly (p = 0.79). By the end of the investigation, there was a reduction in APWV as related to the baseline level in 13 (65%) patients: 7 of them had not one swollen joint and only 5 patients had a CRP level of > 5 mg/l, which was significantly less frequently than that in patients without positive changes in this index: in 6 (86%) of the 7 patients (p = 0.043). There was a direct correlation of changes in APW with those in serum CRP levels (p = 0.012 and p = 0.047, respectively) after 14 and 120 days and with those in serum IL-6 concentrations following 14 days (p = 0.003). 24-hour BP monitoring showed no significant BP change in the patients after 14 and 120 days after injection. The mean level of total cholesterol and triglycerides remained unchanged.

Conclusion. The IL-6 inhibitor canakinumab can have a positive effect on IMT and arterial stiffness. The effect of the drug on the structural and functional properties of the vascular bed is due to the magnitude of its anti-inflammatory activity

Weber-Christian disease (WCD), or idiopathic panniculitis, refers to rare diseases from a group of systemic connective tissue diseases. To verify the diagnosis of WCD is a difficult task, for there are no precise diagnostic tests for this disease.

Objective: to study the clinical features and additional investigation data of WCD as one of the variants of lobular panniculitis (LP).

Subjects and methods. Nineteen patients (2 men and 17 women) aged 32 to 71 years with WCD were examined. The average disease duration was 65.1±11.3 months.

Results. The medical history data of 12 patients could identify three suspected factors of disease development: surgical intervention (n = 6); supercooling (n=4), and acute respiratory viral infection (n=2). In 10 (53%) patients aged 47–71 years, the Quetelet index was as high as 31.8±7.2 cm/kg, which allowed grade 2 obesity to be diagnosed. According to its clinical manifestations, there were 3 WCD forms: nodular (n=10), plaque (n=6), and infiltrative (n=3). The saucer symptom was present in 74%, including in all cases of the chronic course (p=0.02). The number of affected areas significantly differed in the nodular and plaque forms (p=0.01). ROC analysis showed that the optimal values of sensitivity (80%) and specificity (83%) on visual analog scale (VAS) in patients with these forms corresponded to a separation point of 60 mm, with the prognostic value of a positive result being 0.89 (CI 0.71–1.1; p=0.011). The infiltrative form showed a typical clinical picture (VAS, 83.1±12.5 mm) in 3 patients, one of them was found to have mesenteric panniculitis. The level of C-reactive protein was shown to be correlated with the form of the disease; the former being maximal in infiltrative WCD. The pathomorphological examination of skin and subcutaneous fat biopsy specimens from the nodule of all the patients detected diffuse leukolymphocytic infiltration, single multinucleated cells, necrotic foci, and lipocyte proliferation.

Conclusion. WCD is a clinical variant of LP, which requires an extended diagnostic search.

Osteoarthritis (OA) is a degenerative joint disease that is accompanied by cartilage destruction, synovial membrane inflammatory changes, and subchondral bone remodeling.

Objective: to perform comparative evaluation of the efficiency of knee OA treatment with diacerein, hyaluronic acid, and nonsteroidal antiinflammatory drugs at short- and long-term follow-up.

Patients and methods. An open-label comparative enrolled 192 patients with knee arthritis: 68.5% women and 31.5% men (mean age, 52.7±1.79 years; mean disease duration, 7 years). The patients were divided into three groups matched for gender, age, and disease duration: Group 1 (n=63) took diacerein 100 mg/day; Group 2 (n=65) received intraarticular hyaluronic acid 2 ml thrice at an interval of 7 days; Group 3 (n=64) had diclofenac 75 mg/day. The patients of all the three groups had a similar magnitude of its symptoms and Kellgren grade. Magnetic resonance imaging (MRI) and arthroscopic examination of the knee joint were performed to assess the results of treatment in the patients.

Results. To evaluate the chondroprotective effect of the drugs, the authors used their proposed arthroscopic and MRI criteria (sensitivity, 89.7%; specificity, 93.1%) that allow abnormally changed and normal cartilages to be identified. At months 2 of treatment, all the three drugs ensured a considerable pain intensity reduction that persisted till 12 weeks. The important benefit of diacerein and hyaluronic acid was their aftereffect for further 3 months.

Objective: to estimate a need for conservative rehabilitation treatment in patients with juvenile chronic arthritis (JCA).

Material and methods. Data on the principles and procedures of rehabilitation treatment were analyzed in patients with JCA on the basis of 25- year experience. The need for these packages of measures in 1999, 2008, and 2014 was compared. Standard procedures for joints at different sites were described. According to the degree of joint functions, there were rehabilitation treatment packages: corrective, mobilization, and general health-improving.

Results and discussion. All patients with juvenile arthritis need rehabilitation (physical, psychological, and social). Comparison of the total number of patients who had received rehabilitation treatment in 1999, 2008, and 2014 showed a small trend towards its reduction. This is due to the smaller number of patients with dysfunctions and to the larger number of those without movement disorders who had received adequate treatment in early periods of the disease. The high percentage of patients having limited joint functions needs a mobilization package. Analysis of the data available in the literature and the authors' experience may lead to the conclusion that all patients with JCA need exercise therapy. The latter is a major procedure for physical rehabilitation and should be included in the standards for adjuvant treatment during basic medical therapy. Emphasis is laid on the importance of the early initiation of treatment to prevent incapacitating deformity at early stages of the disease.

The paper considers a case of adult-onset Still's disease that occurred as acute pericarditis, two-spike hectic fever, and neutrophilic leukocytosis in a young man. It was difficult to establish a correct diagnosis because there were no characteristic clinical symptoms of Still's disease, such as salmon colored rash, arthralgia, and sore throat. The diagnosis of adult-onset Still's disease was verified on the basis of the classification criteria described by M. Yamaguchi et al. The special feature of the clinical case was the development of steroid resistance and the effective use of a combination of the interleukin-6 receptor blocker tocilizumab (8 mg/kg body weight, given intravenously dropwise once every four weeks) and methotrexate (15 mg/week orally). During this treatment, a sustained clinical and laboratory response was achieved, which could reduce the dose of glucocorticoids to the maintaining one.

Today, it is generally accepted that it is necessary to achieve clinical remission in rheumatoid arthritis (RA) or as minimum a low disease activity. The paper describes a clinical case of a female patient diagnosed with RA who was observed to have inefficiency of standard disease-modifying antirheumatic therapy with methotrexate 25 mg/week, secondary inefficiency of tumor necrosis factor-α inhibitors (adalimumab), and inefficiency/poor tolerance of the interlukin-6 receptor antagonist tocilizumab. This determined the need to use fofacitinib (TOFA), a drug with another mechanism of action. TOFA is the first agent from a new group of immunomodulatory and anti-inflammatory drugs, intracellular kinase inhibitors. Disease remission could be achieved during therapy with TOFA, which enables one to consider this synthetic drug as a therapy option that potentially competes with therapy with biologicals.

The paper considers the very urgent problem of optimization of the management of rheumatoid arthritis (RA) patients who have achieved remission (or persistent low disease activity) during therapy using biologicals. It analyzes the results of BeSt, OPTIMA, HIT HARD, ACT-RAY, AVERT, PRESERVE, RETRO, PRIZE, DRESS, HOPEFUL-2, and HONOR studies, the data of NinJa and CORRONA registries, and the experience gained in treating psoriasis concerning practically important issues, such as whether tumor necrosis factor-α inhibitors and biologicals with other mechanisms of action can be discontinued; whether the whole anti-inflammatory therapy can be stopped; whether the dose of biologicals can be reduced as an alternative to complete discontinuation or as a step to discontinue biologicals; whether repeated or intermittent therapy with biologicals can be used; what value of the depth of suppression of inflammatory activity is in solving the problem of whether biologicals can be discontinued. The current results may lead to the conclusion that in RA the dose of biologicals may be successfully reduced and, in some cases, the latter may be completely discontinued. This possibility seems to be associated with the depth of remission. Repeated use of biologicals generally gives rise to prompt improvement in patients with a recurrent disease-activity rebound. The results of a trial of etanercept are most optimistic. Re-treatment with biologicals generally provides fast improvement in patients with a relapse of disease activity. The results of the trials of etanercept are most optimistic.

The paper discusses possible approaches to determining remission in ankylosing spondylitis (AS) and other axial spondyloarthritides (axSpA). At present, there is no single definition of the concept of remission in axSpA and AS, which is due to both the diversity of manifestations of axSpA and a large number of tools to measure disease activity and the nonsimultaneous change in the degree of clinical and laboratory symptoms, signs of acute inflammation, as evidenced by imaging techniques, and signs of progressive structural changes in the locomotor apparatus in the same patient. Clinical, laboratory, magnetic resonance imaging, and radiographic remissions in a patient cannot be in time, which in turn affects the choice of optimal therapy.

The case report demonstrates problems with treatment correction in a patient who has achieved clinical and laboratory remission in the presence of persistent inflammatory signs in the locomotor apparatus, as shown by imaging techniques. Since the guidelines for the follow-up and treatment of patients with nonradiographic axSpA and AS are similar today, the paper considers remission as a general problem for all subtypes of axSpA.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the classes of drugs that are most needed by modern medicine. Hundreds of new articles on the efficiency and safety of NDAIDs are published in Russian and foreign scientific journals every year. It is difficult for the practitioners to keep track of so a large amount of constantly changing information. So we have decided to present to our readers a concise overview of some of the most interesting, in our opinion, and the newest papers that discuss different aspects of using NSAIDs.

The paper presents a literature review demonstrating the importance of using the damage index (DI) for the comprehensive evaluation of the degree of irreversible organ changes in patients with systemic lupus erythematosus (SLE). The need and prerequisites for creating this reliable tool developed by the Systemic Lupus International Collaborating Clinics (SLICC) Group in 1996 have been substantiated. The emergence of DI is emphasized to be associated with higher survivals in patients with SLE in the past decades and with an increase of their irreversible organ damages that were a consequence of both disease activity and performed therapy. Particular attention is given to the explanation for a possibility of using DI not only to estimate the degree of irreversible organ damages in a specific patient, but also to choose more adequate therapy. According to the guidelines of the US Food and Drug Administration (FDA) and the European League Against Rheumatism (EULAR), DI along with activity indices (SLEDAI, BILAG) is indicated to be included in the comprehensive assessment of performed therapy in patients with SLE.

Ankylosing spondylitis (AS) is a chronic progressive disease resulting in disability. Affecting mainly young and able-bodied people, AS considerably reduces the manpower of society. To date, it may be stated on the basis of the available data, that long-term therapy with tumor necrosis factor-α inhibitors makes it possible not only to improve clinical status, but also to restore working ability. This in turn can lead to the conclusion that the indirect costs associated with this disease can substantially reduce costly treatment-related medical losses of society as the patients return to active labor.

The reasonability of using nonsteroidal anti-inflammatory drugs (NSAIDs) in osteoarthritis (OA) is due mainly to persistent articular tissue inflammation that contributes to the progression of structural changes in the hyaline cartilage, as well as its leading clinical manifestation – pain syndrome caused by damage to different articular structures. NSAIDs are basic rapid-acting symptom-modifying drugs in the treatment of OA. Meloxicam has high anti-inflammatory and analgesic activities. The effect of meloxicam on hyaline cartilage metabolism permits one to consider it as a potential chondroprotective agent. Short- and long-term investigations have demonstrated its good tolerability, including that in patients with polymorbidity. The use of meloxicam does not increase the risk of cardiac and renal complications. The high therapeutic activity of meloxicam along with the low level of adverse reactions determines the pharmacoeconomic expediency of its use.