Panniculitis (PN) is a group of heterogeneous inflammatory diseases characterized by involvement of the subcutaneous fat and frequently locomotor system and viscera. An analysis of the literature suggests that so far there are no studies using a uniform large cohort of patients with different types of PN and further carefully tracking their outcomes over several years. Some authors still question the nosological independence of Weber–Christian PN. The issues of treatment in general and its specific forms remain open. The lack of conventional treatments, regardless of the form of PN, necessitates in vivo clinical trials of various regimens, by compar-ing the course and outcomes of the disease. Recognizing the possible predictors of a relapse in various forms of PN and assessing the long-term results of treatment are of supreme importance since, along with an analysis of the efficiency of different therapy regimens, valuable informa-tion on diverse factors that significantly influence the prognosis of the disease can be obtained.

Orthotic intervention is the most important element in the rehabilitation of patients with rheumatoid arthritis (RA).

Objective: to evaluate the clinical efficiency of orthotic intervention in the rehabilitation of patients with RA.

Patients and methods. The investigation enrolled 70 patients with RA (women, 84.3%; age, 18 to 64 years; disease duration, 3 months to 4 years) who were divided into 4 groups: 3 orthotic groups (ORLETT knee, ankle, and wrist orthoses of various fixation) and one control group (only drug therapy). The number of tender and swollen joints (TJ and SJ), pain on 100-mm VAS, erythrocyte sedimentation rate, C-reactive protein levels, DAS28, HAQ, RAPID3, and FFI scores, knee joint movement amplitudes, step test values, and hand compression force were estimated during 6 months. The clinical efficacy and comfort of orthoses and adherence to orthotic intervention were evaluated.

Results. Six-month knee, ankle, and wrist orthotic intervention caused a reduction in the number of TJ and SJ, pain VAS, HAQ, RAPID3, and FFI scores, and step test values and an increase in knee flexion angle and hand compression force; at the same time, there were significant differences in those observed in the control group. The orthotic intervention failed to affect DAS28 scores and laboratory parameters. This decreased substantially (by more than 50%) the patients' needs for nonsteroidal anti-inflammatory drugs. Both a physician and a patient appreciated the comfort and clinical efficacy of orthoses greatly and adherence to their use well (86.7 to 93.3%).

Conclusion. The 6-month application of knee, ankle, and wrist orthoses reduces pain syndrome and joint swelling and improves locomotor indicators, functional status, and quality of life in patients with RA, which may recommend including orthotic intervention in a comprehensive rehabilitation program.

The Russian model FRAX®, an algorithm for estimating the 10-year absolute risk of fractures, which is based on the identification of risk factors that increase fracture risk, was proposed in 2012 to detect people at high risk for fracture.

Objective: to estimate the sensitivity and specificity of the Russian model FRAX® versus dual energy X-ray absorptiometry (DEXA) for predicting high fracture risk.

Patients and methods. In 2013–2014, the FRAX® questionnaire was retrospectively filled in provided that all information was available in the initial documents on 224 women aged 50 years and older (mean age, 62±7 years), examined at the V.A. Nasonova Research Institute of Rheumatology in 2003–2004. The risk of major osteoporotic fractures was assessed in accordance with the guidelines of the Russian Osteoporosis Association both with and without regard for bone mineral density (BMD+/BMD-) in the femoral neck. The diagnosis of osteoporosis (OP) was based on the WHO criteria using DEXA values.

Results. At a primary examination, 96 (43%) patients had a history of minimal trauma fractures, 105 (47%) had OP in the vertebral column and/or femoral neck; the FRAX® (BMD-) values higher than the therapeutic intervention threshold were seen in 70 (31%) patients. 71 (31%) women had no risk factors included in the FRAX® questionnaire. In accordance with the current guidelines, therapy should be recommended for 146 (65%) patients. Over the 10-year period, minimal trauma fractures occurred in 106 (47%) women, including in 46 (40%) of the 128 patients who had no history of fractures. The sensitivity of the FRAX® algorithm with BMD- and BMD+ was 41% (31–51%) and 38% (29–48%) and its specificity was 77% (68–84%) and 82% (74–88%), respectively. The area un-der the ROC curve (AUC) was 0.66 for FRAX® BMD- and 0.69 for FRAX® BMD+. The sensitivity of BMD values in the spine for predicting OP fractures was greater than that of the FRAX® algorithm and was as high as 53% (43–63%) with a lower specificity of 61% (52–70%) (AUC, 0.61) and these values in the femoral neck were as follows: a sensitivity of 25% (18–35%) with a specificity of 89% (82–94%) (AUC 0.64).

Conclusion. The Russian model FRAX® for major OP fractures, which is calculated both with and without regard for BMD in the femoral neck, and DEXA fail to identify in full measure patients who need antiosteoporotic therapy, which calls for further investigations providing a pharmacoeconomic rationale for the application of these methods.

Objective: to estimate the cost of treatment in patients with complicated osteoporosis (OP) in the first year after fracture under the conditions of the Moscow municipal healthcare system.

Patients and methods. The investigation enrolled 196 women (mean age, 65.8±9.1 years) who had sustained fractures at five major osteoporotic sites (proximal hip (PH), distal forearm (DF), surgical humeral neck, vertebral column, and medial and/or lateral ankle). A unified questionnaire that included data on inpatient and outpatient treatment, patients' personal costs, and social benefits, as well as tariffs on services of the Moscow City Fund of Obligatory Health Insurance was used to estimate the cost of treatment for complicated OP during one year after fracture.

Results. The direct cost of treatment for PH fracture amounted to 101,243 rubles and was significantly higher (p < 0.01) than that for fractures at other sites: DF (22,080 rubles); humeral neck (39,855 rubles), vertebral column (51,167 rubles), and ankle (43,345 rubles). The average cost of treatment in terms of indirect costs of treatment for complicated OP during a year was as high as 61,151 rubles. In the overall cost structure for the disease, hospital costs accounted for 44%; social benefits were 12% and the cost of antiosteoporotic drugs was only 7%, which was associated with the fact that the latter were rarely prescribed by primary healthcare physicians.

Conclusion. Costs of treatment in patients with complicated OP in Moscow were estimated in relation to the site of low-energy fracture. The disease was shown to cause considerable economic losses regardless of the site of osteoporotic fracture; however, the cost of antiosteoporotic drugs has an insignificant share in the overall cost structure for treatment. At the same time, secondary prevention of OP requires that combination antiosteoporotic therapy should be performed in all patients who have sustained low-energy fracture.

Objective: to study the clinical, laboratory, and instrumental features of joint involvement in patients with Löfgren's syndrome.

Patients and methods. Examinations were made in 125 patients, among whom there were 21 men and 104 women (male:female ratio, 1:5); mean age, 42±12 years (from 18 to 69 years), the referral diagnoses were erythema nodosum (EN), panniculitis or vasculitis.

Results. All the patients complained of painful red indurations on the upper and lower extremities; there were also complaints of joint pain (83%), cough, weakness, hyperhidrosis, dyspnea, myalgia, and sore throat (55%), and subfebrile temperatures (50%). Arthralgias were noted in all the cases; 70% had arthritis that was observed manly in the ankle joints (62%). In all the patients, joint damage was concurrent with EN. Articular manifestations preceded EN in 35 (28%) patients. Laboratory tests showed that the median erythrocyte sedimentation rate was 20 [14; 31] mm/hr and C-reactive protein (CRP) was 10 [6; 21] mg/l. Elevated CRP levels were significantly more common in arthritis (p = 0.003) and nodular fusion (p=0.04) and directly related to the number of subcutaneous nodules (p=0.008; r=0.29). Chest computed tomography revealed intrathoracic lymphadenopathy in all the patients; ground glass lung tissue injury (Stage II) was identified in 42% of cases. Joint damage did not depend on the X-ray stage of sarcoidosis. 54% of the patients took nonsteroidal anti-inflammatory drugs, 60% received hydroxychloroquine 600 mg/day, and 50% had glucocorticoids (GC) 4–6 mg/day. 35% of the patients received combined therapy with GC and cyclophosphamide 200 mg/week or methotrexate 15 mg/week. Articular syndrome virtually completely regressed during a year. Arthralgias in the ankle persisted in a few (4%) cases.

Changes in vessel wall stiffness are a sign of endothelial dysfunction and vascular remodeling at reversible, preclinical stages and may be a marker for cardiovascular disease, including in the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Objective: to study changes in vessel wall stiffness indicators in patients with active ankylosing spondylitis (AS) without cardiovascular diseases during short- and long-term therapy with NSAIDS.

Patients and methods. The investigation enrolled 164 AS patients aged older than 18 years. Of them 60 patients took amtolmetin guacil (AMG) daily for 3 months within the framework of the CORONA trial, the other 104 patients received nimesulide at least thrice weekly for 60 months (the index of NSAID use was 56%) within the framework of the PROGRESS study. Vessel wall stiffness indicators (augmentation indices and aortic pulse wave velocity (PWVao)) were studied in all the patients at baseline and after 3 (for those who took AMG) and 60 (for those who received nimesulde) months.

Results. At baseline, AS activity and cardiovascular risk factors were comparable in the short- and long-term follow-up groups. The mean values of aortic augmentation index (AixAo) in the patients taking AMG were 13.5% [6.08; 22.08] at baseline and 14.25% [9.4; 24.25] after 3 months of therapy (p=0.18); PWVao was 7.7 [6.72; 9.41] and 8.46 [7.28; 9.96] m/sec, respectively (p=0.007). At the same time, PWVao was >10 m/sec only in 6 (10%) patients at baseline and in 12 (20%) following 3 months. In the group of patients taking NSAIDs long, AixAo was 21.5% [11.08; 34.25] at baseline and 18.25% [09.33; 26.28] at week 12 (p=0.3); PWVao was as high as 7.6 [6.56; 7.91] at baseline and 7.8 [7.22; 8.1] m/sec at week 12 (p=0.12). The PWVao of >10 m/sec was found in 20 (19.2%) patients at baseline and in 22 (21.15%) after 60 months of follow-up and treatment. The number of patients with unidirectional changes in vessel wall stiffness indicators did not differ in the 3- and 60-month use of NSAIDs.

Conclusion. During 3-month NSAID therapy, the patients with AS showed a slight increase in PWVao in the absence of changes in the other indicators of vessel wall stiffness. At the same time, the mean values of PWVao remained within the normal range and its increase >10 m/sec was detected only in 20% of the patients. Long-term NSAID therapy in AS patients without cardiovascular diseases was unaccompanied by a change in the values of vessel wall stiffness and PWVao.

The Foot Functional Index (FFI) questionnaire most completely reflects the functional status of patients with joint diseases of the feet.

Objective: to study the psychometric properties of a Russian-language version of the FFI questionnaire.

Patients and methods. The reliability, sensitivity, and validity of the Russian-language version of the FFI questionnaire were assessed in 55 patients with rheumatoid arthritis (RA). The investigators checked the reliability by assessing the internal consistency (calculating Cronbach's alpha) and reproducibility by a test-retest analysis. The criterion validity was evaluated by correlation analysis using HAQ, RAPID3, and pain visual analogue scale (VAS) scores. The sensitivity of FFI was studied by comparing its dynamics with RAPID3 changes during treatment.

Results. Evaluating the internal consistency yielded a high Cronbach's alpha (0.78). The test-retest analysis demonstrated a significant correlation (0.83) between the results of primary and secondary testing. Assessing the criterion validity showed a high or near-high relationship to the scores of RAPID3 (0.78), HAQ (0.69), and pain VAS (0.76). The group of patients who were observed to have a decrease in disease activity according to RAPID3 from a high (16.2±4.1) to moderate (10.5±5.2) degree displayed a more marked reduction in FFI (ΔFFI = 20.5±2.3) than the group that did not exhibit significant changes in disease activity (ΔFFI = 6.9±3.4).

Conclusion. FFI is a reliable, valid, and sensitive tool to evaluate the functional status of patients with foot diseases in RA.

Tofacitinib (TOFA), a member of a new class of targeted synthetic disease-modifying antirheumatic drugs (DMARDs), is a promising medication for the treatment of rheumatoid arthritis (RA) and other immunoinflammatory diseases. The paper describes the Russian experi-ence with TOFA used to treat severe RA.

Patients and methods. 101 RA patients (18 men and 83 women; mean age, 51.03±11.28 years; mean disease duration, 105.4±81.43 months) who were positive for rheumatoid factor (89.1%) and anti-cyclic citrullinated peptide antibodies (74.7%) and resistant to therapy with synthetic DMARDs (sDMARDs) (80.2%) and biological agents (19.8%) were given TOFA at a dose of 5 mg twice daily, which could be doubled if necessary. TOFA was used alone (n=9) or in combination with methotrexate (MT) (n=75) or other sDMARDs (n=17). The achievement of low disease activity (LDA) and clinical remission at 3 and 6 months of treatment by DAS28-ESR SDAI, and CDAI scores, and the indices of safety and tolerability were assessed.

Results. A total of 93 (92.1%) of the 101 patients completed a 24-week period of the investigation. 8 (7.9%) patients prematurely discontinued TOFA after an average of 2.75±0.71 months. At the end of the study, the patients achieved the primary endpoint (LDA including remission) in terms of DAS28-ESR ≤3.2 (34.7%), SDAI ≤11 (47.5%), and CDAI ≤10 (48.5%) and the secondary endpoints (clinical remission) in terms of DAS28-ESR ≤2.6 (17.8%), SDAI ≤3.3 (8.9%), and CDAI ≤2.8 (6.9%). When TOFA was combined with MT, the discontinuation rate for the former was significantly lower (2.7%) than when TOFA was used in combination with other sDMARDs (29.4%) or alone (11.1%; p<0.01). At 3 and 6 months of follow-up, LDA was achieved more frequently when TOFA was combined with MT than when other treatment regimens were used. Fatal outcomes and serious adverse events (AEs), as AEs previously undescribed in the literature, were not seen during a follow-up within the framework of the clinical trial. Only 2 patients discontinued TOFA because of AEs.

Conclusion. The use of TOFA in RA is effective in achieving LDA in patients unresponsive to sDMARDs and biological DMARDs. The prescription of the drug makes it possible to monitor the activity of the inflammatory process and, with its sufficient safety and good tolerability, to achieve LDA in half of the patients, including those with multidrug resistance.

The review represents the results of investigations into the role of nondrug methods in the treatment and prevention of osteoporosis (OA). The data available in the literature suggest that a number of non-drug technologies, first of all exercise therapy, aquatic therapy, reflexotherapy, electrical stimulation, and electromagnetic therapy, have proven efficiency and a certain potential for reducing the risk of osteoporosis and its complications and for improving bone metabolism. Expanding the range of these methods and increasing their validity for clinical introduction are very promising.

This review deals with infection caused by Herpes zoster (HZ) reactivation in rheumatic diseases (RD). The absolute majority of studies show that the incidence of HZ infection in RD is 2–10-fold higher than the population one. Patient age, gender, use of glucocorticoids, and duration and severity of the disease are identified as risk factors. Vaccination against HZ infection is sure to be important for patients with RD. Investigation of the efficacy and safety of a new adjuvant NZ/su vaccine in patients with RD is of interest today.

The paper presents the results of recent studies of the efficacy of golimumab (GLM) in the treatment of uveitis in patients with ankylosing spondylitis (AS). The data obtained in these studies suggest that GLM is highly effective in relieving and preventing uveitis attacks. However, all the given studies have a number of disadvantages; primarily they have included a limited number of patients. Further prospective randomized clinical trials with large sample sizes are required to evaluate the efficacy and safety of GLM for the treatment of uveitis in patients with spondyloarthritis.

Osteoarthritis (OA) is not a single nosological entity, but it is a group of diseases with different origins. Nevertheless, the similarity of morphological and clinical manifestations of these diseases determines a common approach to their diagnosis and treatment. The ambiguous results obtained in a number of studies dealing with the treatment of OA can be largely associated with the heterogeneity of included patient groups. The development of OA is the result of combined influence of many factors; it is not inconceivable that some of these factors in some patients may assume a dominant importance, determining the development of special OA types. It is likely that a few of these types: metabolic, inflammatory, traumatic, and subchondral bone change-induced ones, can be identified. The therapy chosen in terms of the pathogenetic type of the disease could provide better results than that performed in accordance with standard recommendations. However, today there are no clear criteria that could form appropriate patient groups.

Epidural injections (EI) of glucocorticoids (GC), the so-called blockades, are frequently recommended a very effective and most modern treatment for nonspecific back pain and lumbar ischialgia. However, EI of drugs (local anesthetics (LA)) for back pain relief has been practiced ever since 1901 when it was first used by the French physicians J.F. Sicard and F. Cathelin, i.e. it belongs to the oldest therapeutic procedures. Moreover, experts' opinions as to the therapeutic value of EI of GC are rather contradictory. The data of a large number of clinical trials fail to confirm the unambiguous advantage of epidural GC used in combination with LA as compared to the effect of the latter only. According to a number of experts, the effect of EI of GC is only slightly better than that of placebo (physiologic saline) and little affects long-term treatment results. Epidural GC may result in rare but very serious, life-threatening complications. Obviously, this method should be used, only after carefully weighing its potential benefits and risks. In any case, EI of GC should not be considered as an alternative to other pharmacological and nonpharmacological therapies.

The paper presents a new edition (2014) of basic approaches to therapy of rheumatoid arthritis (RA) based on the principle of «Treat to target », which has been elaborated by the experts of the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). The revised recommendations consider the results of numerous randomized controlled and cohort studies, as well as the data of an extensive systematic review of the literature. The new 2014 version contains 4 basic principles and 10 recommendations for the management of patients with RA. When making the updated recommendations, the experts took into account particularly issues, such as criteria for defining a remission, the need to minimize comorbidities in patients with RA and to individualize its therapy, as well as their working ability. The basic principles in the management of patients with RA, by using a treat-to-target strategy, are discussed in detail and the rewording of the main points of the 2010 recommendations and their new edition are substantiated.

On April 9–10, 2016, Sochi hosted the Second National Rheumatology and Dermatology Summit on the questions of therapy in rheumatology and related specialties: what, where, when? Leading Russian and foreign experts took part in this event.