Due to that one patient may be at high risk for developing several immunoinflammatory diseases (psoriasis, psoriatic arthritis (PsA), and Crohn's disease (CD)), their early diagnosis and adequate therapy are extremely relevant. The Interdisciplinary Working Group that includes experts in rheumatology, gastroenterology and dermatology has developed draft guidelines for early diagnosis, methods for activity assessments and for indications for the use of biological agents in patients with concomitant immunoinflammatory diseases (psoriasis, PsA, and CD). In accordance with the decision adopted by the Council of Experts and with the results of a discussion with experts from different regions of the Russian Federation, further steps will be undertaken to validate the guidelines.

Ankylosing spondylitis (AS) more often develops in the 3rd and 4th decade of life when many women think about motherhood. Today, the view which has prevailed since the middle of the 20th century on AS as a male disease has been revised; the male to female ratio for this disease is approaching 1:1, which makes it urgent to study the problem of pregnancy in AS. The review gives the data available in the literature on fertility in AS, the interaction of the latter and pregnancy, and drug therapy during gestation. There is evidence for further investigations to clarify the course of AS, to optimize the assessment of its activity and patients' functional status, to identify markers for an exacerbation of the disease during pregnancy and after childbirth, and to standardize drug therapy when preparing for pregnancy and during the latter.

Chikungunya fever (CF) is a feral nidal viral disease with the mechanism of transmission by Aedes mosquitoes. All increasing migration flows have carried brought the infection to new regions and, consequently, expanded the disease area, including European countries. CF is of undoubted interest for rheumatologists primarily due to the development of severe joint syndrome (arthralgia/arthritis) developing at all stages of the disease. This review gives data on the etiology, pathogenesis, and epidemiology of CF. It describes in detail the clinical presentations of this disease, methods for its diagnosis and differential diagnosis, as well as main approaches to its therapy.

The review presents the data available in the literature on the use of the lupus band test (LBT) for systemic lupus erythematosus (SLE). LBT is a direct immunofluorescence method used to detect immunoglobulins and complement factors in the dermoepidermal junction of skin biopsy specimens. LBT may be applied as one of the diagnostic tests for early diagnosis of SLE in patients without skin manifestations and in those of incomplete SLE. Like the results of other laboratory tests, those of LBT may be taken into account when establishing a final diagnosis only in conjunction with other clinical, immunological and instrumental data.

Osteoarthritis (OA) is a progressive joint disease that causes persistent pain, limited joint function, disability, and loss of social activity. One of the most popular OA treatment options is intra-articular (I/A) hyaluronic acid (HA) injections. This procedure was introduced into clinical practice in the early 1980s and is used universally. To date, there is no consensus on the therapeutic value of HA. Many investigations confirm that HA is effective as not only a symptomatic agent, but also a structure-modifying one. Some works also show that the effect of HA is equal or only slightly superior to that of placebo (I/A saline injection). The review describes the mechanism of action and comparative efficacy of various (lowand high-molecular weight) HA preparations, as well as the safety of their use in real clinical practice.

Chronic pain in the spine is one of the most urgent medical problems. Clinical and instrumental studies fail to reveal that most patients with back pain have any structural changes that may contribute to its occurrence. It is considered that the pain may be caused by the strain of muscles and ligaments located in the lower back, by the overload of these segments, and by detraining. If the cause of the pain syndrome cannot be established, the pain in the spine is regarded as nonspecific. It is believed that behavioral, psychological, and social factors can play an important role in the development of pain. Therefore, current guidelines propose to apply a biopsychosocial approach in patients with back pain. At the same time, much attention is paid to patient self-treatment, exercise therapy, psychotherapy, and some other auxiliary methods. When nonpharmacological interventions are insufficiently effective, drug therapy is indicated. Nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, opioid analgesics, and muscle relaxants are used to treat nonspecific spinal pain. Pharmacotherapy is usually initiated with the use of NSAIDs. They can effectively relieve pain sndrome, but the possibilities of their use in a large proportion of patients are significantly limited due to adverse reactions (ARs). Gastrointestinal and cardiovascular ARs most commonly occur. The likelihood of ARs can be substantially reduced by the use of aceclofenac (AirtalR) that is characterized by a favorable gastrointestinal and cardiovascular safety profile. Paracetamol, opioid analgesics, and muscle relaxants are also used in the combination treatment of these patients.

The review is devoted to the most common monogenic autoinflammatory disease – familial Mediterranean fever (FML) caused by MEFV gene mutation that occurs mainly in the representatives of certain ethnic groups and manifests itself as recurrent 6–72-hour attacks of pyretic fever accompanied by the phenomena of aseptic peritonitis, pleurisy, arthritis, and inflammatory rash. The disease can lead to a life-threatening complication, such as amyloidosis. FML is noted to be comorbid with a number of other inflammatory diseases: systemic vasculitis, chronic joint inflammatory diseases, and inflammatory bowel diseases. Emphasis is laid on the therapy aspects set out in the 2016 EULAR guidelines. The mainstay of treatment for FML is colchicine that prevents recurrences of the disease, minimizes the risk of amyloidosis, and should be prescribed immediately, once diagnosed. The paper deals with the definition of colchicine resistance that is observed in 5–10% of patients. Biological agents, among which interleukin-1 are most preferred, are now used to treat this category of patients. The high efficacy of these agents in patients with FML has been confirmed in randomized controlled studies.

Febuxostat is a non-purine selective inhibitor of isoforms of xanthine oxidoreductase (XOR), the effect of which is aimed at lowering the level of serum uric acid (UA). Febuxostat is a more potent inhibitor of XOR than allopurinol, as confirmed by that target UA levels have been achieved more frequently with febuxostat than with allopurinol, particularly in patients with high serum urate concentrations. The pharmacokinetic properties of febuxostat are not dependent on renal clearance, which distinguishes it from allopurinol and may benefit patients with chronic kidney disease. A number of studies are being conducted to further evaluate the cardiovascular safety of febuxostat and its possible positive effects in preserving renal function. Of importance is the fact that febuxostat does not require dose adjustment in elderly patients.

Objective: to estimate the prevalence of individual risk factors (RFs) for osteoporosis (OP) and fractures, the frequency of high-risk osteoporotic fractures by the Fracture Risk Assessment Tool (FRAXR) and OP according to distal forearm X-ray densitometric findings in men aged 50 years or older in different regions of Russia.

Patients and methods. Random cluster proportionally stratified samples of men aged 40 years or older were formed in the district polyclinics of 23 towns of the country with over 100,000 people in the framework of the social program «Osteoscreening-Russia» (OSR). The survey was conducted using a unified questionnaire. Screening also involved a densitometric study of distal forearm bone mineral density using a peripheral X-ray osteodensitometer (Osteometer Meditech DTX-200). The final analysis included 5057 men from 14 towns of 5 federal districts (FDs) of Russia.

Results. Estimation of the prevalence of individual RFs for osteoporotic fractures in men aged 40 years or older showed that the most common RFs were insufficient dietary calcium intake (91%), smoking (30%), low-energy fractures in the history (20%), low physical activity (16%), and secondary causes of OP (11%). The men in the Ural FD (UFD), Siberian FD, and Central FD were more frequently found to have ≥3 RFs. 5% of men aged 50 years or older were at high risk for osteoporotic fractures by FRAXR, whereas the frequency of OP according to peripheral densitometric findings was 19%. The inhabitants of the North-Western FD and UFD had the greatest need for medical and preventive measures, which was identified by the FRAXR algorithm.

Conclusion. The OSR survey could reveal the most common clinical RFs for OP and osteoporotic fractures in men in 5 regions of the Russian Federation, insufficient dietary calcium intake and assess the risk of osteoporotic fractures and the rate of OP according to peripheral densitometric findings.

In recent decades, the prevalence of hyperuricemia (HU) is increasing worldwide; the role of uric acid (UA) in the genesis of various metabolic disorders, cardiovascular diseases, and kidney disease is being discussed. There are very few investigations of the rate of HU and its role in the development of diseases in certain social groups, including in professional athletes.

Objective: to estimate the prevalence of HU and its role in the genesis of various pathological conditions and metabolic disturbances in professional athletes.

Patients and methods. A retrospective comparative one-stage study was conducted, for which 2148 athletes who met inclusion criteria were selected and examined in the Federal Research and Clinical Center for Sports Medicine and Rehabilitation, Federal Biomedical Agency, in 2015. A control group consisted of 99 ageand sex-matched healthy volunteers examined at the V.A. Nasonova Research Institute of Rheumatology in 2017. The analysis included a comparison of the rate of HU and other examined parameters in professional athletes and healthy volunteers. The examined parameters were separately compared in athletes with/without HU, followed by statistical processing of results.

Results. HU was detected in 306 (14.2%) of the 2148 athletes, more often in men (n=253 (20%) than in women (n=53 (6%); (p<0.001). The rate of HU in the athletes was comparable with that in the healthy population (12.1%). The athletes with HU (n=306) compared with the other athletes (n=1842) had the following statistically higher indicators: the mean serum levels of creatinine, triglycerides, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltranspeptidase, creatinine phosphokinase, and myoglobin, glomerular filtration rate, and body mass index (BMI) (p<0.00001 for all cases).

Conclusion. HU is detected quite often in professional athletes (14.2%), which is comparable with the indicators seen in healthy volunteers (12.1%). The high prevalence of HU and its association with indicators reflecting kidney function, lipid metabolic disturbances, and BMI necessitate further investigations aimed at searching the causes of HU and methods of its prevention and treatment in professional athletes.

Objective: to evaluate kidney function in patients with spinal degenerative-dystrophic diseases (SDDDs) who take nonsteroidal anti-inflammatory drugs (NSAIDs) as repeated short cycles of treatment for severe back pain.

Patients and methods. The investigation enrolled 97 patients with SDDDs who took NSAIDs for back pain (a study group). A control group consisted of sexand age-matched healthy individuals who had not used NSAIDs within the past year (n=40). Glomerular filtration rate (GFR) was estimated using the CKD-EPI equation and markers of kidney injury (albuminuria and globulinuria) were measured.

Results. In the study group, GFR was decreased to <90 ml/min/1.73 m2 in 61 (62.9%) patients, to <60 ml/min/1.73 m2 in 11 (11.3%); the mean GFR was 77.5 [68.0; 89.0] ml/min/1.73 m2; in the control group, a decline in GFR to 89–60 ml/min/1.73 m2 was recorded in 35 (62.5%) cases; this indicator was >90 ml/min/1.73 m2 in the remaining 15 (37.5%) cases; the mean GFR was 82.5 [70.8; 90.0] ml/min/1.73 m2 (p≥0.05 for all pairwise comparisons). A decrease in GFR to <60 ml/min/1.73 m2 was found in 11 (11.3%) patients in the study group and in nobody in the control group (p=0.026). Elevated albuminuria was noted in 74 (76.3%) patients with SDDDs and in 9 (22.5%) healthy individuals (p<0.05). Albumin/creatinine ratio was 57.1 [33.8; 82.4] mg/g in the study group and 25.0 [17.5; 32.9] mg/g in the control group (p<0.0001). Increased globulinuria was established in all the patients with SDDDs and only in 3 (7.5%) healthy examinees. Globulin/creatinine ratio was 134.7 [77.5; 197.7] mg/g in the study group and 12.9 [0.5; 18.1] mg/g in the control group (p<0.0001).

Conclusion. A decline in GFR to <60 ml/min/1.73 m2 was more often seen in the patients taking NSAIDs for spine pain caused by SDDDs than in the healthy individuals. In case of comparable GFR, the level of kidney injury markers was significantly higher in the study group than that in the control group, which suggests that patients with SDDDs who take NSAIDs have subclinical tubulointerstitial and glomerular changes.

The paper discusses whether biological agents (BAs) may be used as monotherapy. The combination of different BAs and methotrexate (MTX) allows a good result in patients with juvenile idiopathic arthritis refractory to standard antirheumatic therapy. The efficiency of this therapy meets the ACRpedi50 criteria in 80–90% of patients; one third of patients can achieve the inactive stage of the disease. When BAs are administered, the frequency of use of nonsteroidal anti-inflammatory drugs and glucocorticoids is reduced. In only 15% of patients, MTX can be discontinued during the first year of therapy with BA, significantly more frequently with tocilizumab.

Objective: to assess functional results and quality of life in patients with rheumatoid arthritis (RA) after reverse shoulder joint replacement.

Patients and methods. Examinations were made in 37 patients with RA involving the shoulder joint, who underwent shoulder joint replacement using a reverse DeltaX-tend DePuy prosthesis in 2006–2017. The investigators studied the volume of movements, the level of pain using the visual analogue scale, the function of the shoulder joint using the American Shoulder and Elbow Surgeons (ASES) Shoulder Score and the upper limb as a whole by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, a patient's functional status by the Health Assessment Questionnaire (HAQ), quality of life (QL) by EQ-5D (Euro Quolish instrument) and analyzed shoulder X-ray films before and in the late periods after surgery.

Results. The volume of shoulder joint movements was found to increase. At 28.7 months postsurgery, the mean volume of flexion, abduction, and external rotation was 107.4Ѓ}15.2, 128.3Ѓ}8.5, and 46.4Ѓ}5.5°; respectively (p≤0.05). The patients experienced no pain in the late periods following surgery. Prior to surgery and at control examination, the mean ASES scores were 25.0Ѓ}4.7 and 79.4Ѓ}6.4, respectively (p≤0.05). Before surgery, the mean DASH score was 63.8Ѓ}4.2; in the late periods it decreased to 18.2Ѓ}8.6 (p ≤ 0.05). The mean preoperative HAQ score was 2.81; following surgery, it also decreased to 1.39 (p≤0.05). The postoperative EQ-5D QOL index score increased from 0.41 to 0.72. The rate of complications reached 10.8%.

Conclusion. Reverse endoprosthetic replacement for end-stage shoulder joint damage (Larsen 4–5) with rotator cuff defect makes it possible to increase the volume of movements, to reduce pain, and to improve upper limb function, functional status, and quality of life in patients with RA.

The novel targeted synthetic disease-modifying antirheumatic drug apremilast (AP), a phosphodiesterase 4 inhibitor, is currently used to treat psoriasis and psoriatic arthritis (PsA). AP treatment can reduce the level of proinflammatory cytokines and the activity of inflammatory changes. The article describes a clinical observation of the efficacy of AP in PsA. It is demonstrated that AP used at a dose of 60 mg/day for moderate PsA activity leads to a reduction in the manifestations of peripheral arthritis, psoriasis (both during monotherapy and in combination with methotrexate), as well as to the achievement of low or minimal disease activity. It is shown that AP is generally well tolerated by patients.

The paper describes a case of rheumatoid arthritis in a 58-year-old female patient who sought medical advice for complaints of a massive soft tissue tumor upon the anterior and lateral surfaces of the left elbow joint. Left elbow bursitis was suspected. Magnetic resonance imaging showed a relationship between the massive tumor (anastomoses) and the joint. A surgical intervention was undertaken. A cyst consisting of two components was excised; anterolateral synovectomy and plastic surgery of the anterior elbow joint capsule were performed. The patient was examined 6 months later; the result was satisfactory.

This article reviews data on the assessment of the incidence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA, arthropathic psoriasis), as well as related disability and the economic burden of these nosological entities, including their therapy with biological agents. It considers the issues of organization and quality of medical care, drug supply, normative and legal regulation. The paper also shows the important epidemiological and socioeconomic importance of RA, AS, and PsA in Russia, points out the regional peculiarities of medical care and drug provision, and proposes solutions for their optimization at the federal and local levels. In preparing this investigation, the authors have taken into account the opinions of many specialists and experts in this field from different subjects of the Russian Federation.

The paper discusses the problem of laboratory monitoring in therapy with disease-modifying antirheumatic drugs (DMARDs) and biological agents (BAs) in patients with rheumatoid arthritis (RA). Due to the risk of adverse reactions, in particular to that of cardiovascular diseases, hepatotoxicity, hematological disorders, deterioration of renal function, infections, and bleeding caused by the use of DMARDs and BAs, recommendations are needed to have a list of tests for laboratory monitoring during this therapy and the frequency of their implementation in patients with RA.