Systemic lupus erythematosus (SLE) is a systemic autoimmune disease of unknown etiology, which is characterized by the hyperproduction of organ-nonspecific autoantibodies to various components of the cell nucleus with the development of immunoinflammatory tissue and visceral damages. Kidney damage is one of the most common severe manifestations of SLE, which develops in 40–80% of patients and, in 15–20% of them, progresses to end-stage renal failure. A renal biopsy is recommended for all patients with lupus nephritis (LN) when choosing a successful treatment policy added by immunosuppressive therapy.

The paper presents treatments for LN according to its morphological class with a dosage detailed description, a route of administration, and the duration of intake of different drug groups in the induction and maintenance phases of treatment, as well as the specific features of therapy for refractory LN. Taking into account that patients with SLE in general and those with LN in particular have an increased rate of cardiovascular events, the authors have proposed exposures to traditional and specific risk factors for cardiovascular diseases.

Regulatory T cells (Tregs) is a CD4+ lymphocyte subpopulation that maintains autotolerance by suppressing the activity of autoreactive lymphocytes. There is a hypothesis that functional defects or a smaller number of Tregs underlie the pathogenesis of a number of autoimmune diseases. The paper considers the main features of the phenotype of Tregs. It discusses the number of Tregs in both peripheral blood and affected organs in systemic lupus erythematosus, as well as the time course of changes in the level and functional abilities of different subpopulations of Tregs during immunosuppressive therapy. In addition, the paper presents various approaches to using Treg lymphocytes in the therapy of autoimmune diseases.

Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology, in which different parts of the immune system and other tissues are involved and joint destruction also occurs. Current therapy methods are aimed at suppressing inflammation and reducing pain; however, they do not affect the pathophysiological and biochemical mechanisms involved in joint destruction. Moreover, RA patients are an exclusively heterogeneous group, so not all of them respond equally well to treatment. In this regard, there is a need for personalized therapy. However, the patient's assessment, including clinical, immunological, and radiological parameters, does not currently allow the response to anti-rheumatic treatment to be predicted in about half of the cases. Just the same, recent studies suggest that patient stratification according to the blood level of proinflammatory genes can help predict a response to antirheumatic therapy.

The paper gives data on the efficacy and safety of tumor necrosis factor-α(TNF-α) inhibitors used in first- and second-line therapy. It describes options to optimize treatment with TNF-αinhibitors in first-line therapy, by increasing the dose, which is accompanied by the greater effect only with infliximab; by changing the dose of concomitant disease-modifying antirheumatic drugs, primarily methotrexate (MTX), the use of which increases the probability of achieving the effect of TNF-αinhibitors, the magnitude of the effect rises with the larger doses of MTX or with its parenteral formulation. There are data on the effectiveness of switching from the first TNF-αinhibitor to the second TNF-αinhibitor or to a biologic agent with another mechanism of action.

Drug-induced lupus (DIL) is an autoimmune phenomenon that has similar clinical and laboratory manifestations with idiopathic systemic lupus erythematosus (SLE). About 100 drugs are now known to be associated with the development of DIL. Its diagnosis is verified in the presence of a chronological relationship between the long-term administration of drugs and the mandatory presence of one clinical and one laboratory diagnostic criteria for SLE.

The paper deals with the etiology, pathogenesis, and differential diagnosis of DIL. It presents a spectrum of drugs that can cause DIL and considers the features of its different forms.

Based on the recent data available in the literature, the authors analyze the occurrence of autoimmune responses due to the useof biologic agents (BAs), primarily tumor necrosis factor-αinhibitors. Therapeutic approaches for DIL are discussed. Recommendations are given for screening the patients in the use of BAs. Clinical examples are provided.

Gout is associated with the high frequency of comorbidities, among which there are cardiovascular disease and kidney diseases. In this case, cardiovascular mortality rates are in the first place among the causes of death in patients with gout and exceed the death rates in the population. This may be associated with the main signs of gout, such as a high serum uric acid (UA) level and its related chronic inflammation. Drug correction of hyperuricemia is the mainstay of gout therapy and it is supposed to be able to neutralize the negative effect of UA on the risk of its associated adverse events. Xanthine oxidase inhibitors (allopurinol and febuxostat) are first-line urate-lowering agents. Their effect on UA levels, comorbidities, long-term outcomes (including overall and cardiovascular mortality, development and progression of chronic kidney disease), and occurrence of adverse reactions is studied in large-scale studies, the results of which may affect the strategy of such therapy.
The paper discusses the advantages and disadvantages of the CARES (Gout and Cardiovascular Morbidities) study that has compared the cardiovascular safety of allopurinol and febuxostat. The findings suggest that there is no substantial difference in the frequency of cardiovascular events with febuxostat and allopurinol, but at the same time these demonstrate a high risk for cardiovascular and overall mortality in the febuxostat group. Analysis of this paper cannot conclude that there is a greater cardiovascular risk with therapy with febuxostat; however, it shows that when compared with allopurinol, this risk may be higher. A more detailed study of this issue is required after obtaining the results of already started and planned investigations comparing the effects of allopurinol and febuxostat on the risk of adverse cardiovascular events in patients with asymptomatic hyperuricemia.

The current guidelines for prescribing analgesic therapy for osteoarthritis (OA) are based on the latest knowledge about the pathogenesis of this disease and the mechanism of action of analgesics. The leading principle of choosing analgesics is to assess the nature of pain and the patient's condition, adverse drug reactions. This is directly related to nonsteroidal anti-inflammatory drugs (NSAIDs) that are now the most important class of painkillers used in OA. Among the drugs of this class, meloxicam, a representative of the oxicam group, which relatively equally inhibits cyclooxygenase 1 and 2 and also affects the activity of microsomal prostaglandin E2 synthase 1, should be identified. This drug is characterized by a proven efficacy and a favorable safety profile. Nevertheless, the need for multifactorial evaluation of treatment-associated complications should be recognized as a priority when using any NSAIDs.

Osteoarthritis (OA) belongs to diseases with high comorbidity and is most frequently concurrent with hypertension and other cardiovascular diseases (coronary heart disease, atherosclerosis), obesity, and diabetes mellitus. The paper deals with the use of delayed-release symptomatic medications in the treatment of patients with OA and comorbidity. It reviews clinical trials of the efficacy and safety of diacerein in OA patients and its effect on comorbidity. The paper discusses the possibility of using diacerein as an alternative to traditional nonsteroidal anti-inflammatory drugs in patients with contraindications to the latter.

Osteoporosis is a chronic disease requiring long-term treatment aimed at reducing the risk of low-energy fractures, by improving the quality and strength of bones when taking this or that drug. Bisphosphonates (BPs) are deposited in the bone, so that they have an aftereffect. Due to the increased risk of adverse reactions with BPs, the author considers that the patients may take a drug holiday or be switched to alternative therapy. Denosumab may be used continuously for years and, unlike BPs, does not require discontinuation. It is effective in both untreated and already BP-treated patients. At the same time, when the treatment is discontinued, the effect of denosumab is reversible; therefore, oral BP or intravenous zoledronic acid is recommended to maintain the achieved effect.

The possibilities of rheumatoid arthritis therapy have been significantly expanded today. In addition to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biologic agents (BAs), and a targeted synthetic DMARD, a control treatment strategy has been put into practice.

The paper demonstrates successes in the early prescription of csDMARD and the implementation of treat-to-target principles – to achieve the goal after 6 months in 50% of patients receiving subcutaneous methotrexate and 45% of those using a Leflunomide generic. During this therapy, there is a lower need for BAs and targeted synthetic DMARDs. The priority problem is to train general practitioners in methods for the early detection of RA and to set up schools for these patients.

The paper gives the results of the phase III clinical trial of adalimumab (ADA) biosimilar, (BCD-057) (BIOCAD, Russia), which demonstrate the clinical equivalence of the biosimilar to the ADA innovator Humira® in patients with moderate and severe psoriasis.
Objective. The BCD-057-2/CALYPSO phase III international, multicenter, randomized double-blind clinical trial of the efficacy and safety of BCD-057 (International Nonproprietary Name (INN): adalimumab, ZAO «BIOCARD», Russia) versus Himura® (INN: adalimumab (OOO «Abbvie») in patients with plaque psoriasis aims to prove the equivalent pharmacokinetics, efficacy, safety, and immunogenicity of these medicines in both direct parallel comparison and subsequent switching from innovator to biosimilar.
Patients and methods. The investigation enrolled 346 adult patients diagnosed with moderate to severe plaque psoriasis lasting at least 6 months. After screening, the patients were randomized in a 1:1 ratio into BCD-057 or Humira® groups. At week 24, the patients taking Humira® were re-randomized 1:1 into a group to continue treatment with the ADA innovator or into that to switch to BCD-057. The primary efficacy endpoint was to estimate the proportion of patients who had achieved a 75% improvement in Psoriasis Area and Severity Index (PASI75) at week 16. The secondary endpoints included the assessment of the time course of changes in the skin, nails, degree of itching, and quality of life at weeks 16 and 24. Safety was evaluated from the incidence of treatment-associated adverse events (AEs), cases of severe toxicity (grades 3–4 AEs according to the Common Terminology Criteria Adverse Event (CTCAE) 4.03), cases of early patient withdrawal due to AEs, as well as cases of toxicity potentially associated with the use of tumor necrosis factor-α inhibitors. Immunogenicity was determined using the validated test of patient serum samples for binding antibodies (BAb) and neutralizing antibodies.
Results and discussion. The per-protocol population for efficacy evaluation included 342 patients. At week 16, the primary endpoint of PASI75 was shown to be achieved by 62.5% (105/168) and 66.46% (109/164) of the patients in the BCD-057 and Himura® groups, respectively; p=0.45). The difference between the groups in PASI75 responses was 3.22% with 95% confidence interval [-14.25%; 6.32%]. The analysis of additional endpoints revealed no significant differences in the efficacy of the biosimilar and innovator. During 24 weeks of the investigation, treatment-associated AEs were recorded in 31.03 and 25.58% of the patients in the BCD-057 and Humira® groups, respectively (p=0.31). The proportion of patients with BAb detected at 16 weeks of the investigation was 25.44 and 24.07% in the BCD-057 and Humira® groups, respectively (p=0.87).
Conclusion. The investigation provided convincing clinical evidence for of the equivalent efficacy, safety, and immunogenicity of BCD-057 and Humira®.

Objective: to study the efficacy, immunogenicity, and safety of a 23-valent pneumococcal polysaccharide vaccine (PPSV-23) in patients with rheumatoid arthritis (RA) receiving disease-modifying antirheumatic drugs (DMARDs) and biologic agents (BAs) during a 5-year follow-up.Patients and methods. The investigation included 79 RA patients with a recent history of ≥2 episodes of lower respiratory tract infections (bronchitis, pneumonia). A single dose (0.5 ml) of PPSV-23 was administered subcutaneously during continued methotrexate/leflunomide therapy or 28–30 days before using TNF-α inhibitors. All the patients were followed up during the first year; 39 patients at 24 months (Visit 5), 13 at 36 months (Visit 6), 23 at 48 months (Visit 7), and 18 at 60 months (Visit 8).Results and discussion. RA patients receiving various therapies were noted to have a marked positive immune response to PPSV-23, which was manifested by a significant increase in the postimmunization response coefficient. Vaccination responses were recorded in 61% of the patients with RA. The level of postvaccination responses tended to decrease at the 4-year follow-up. Only one case of community-acquired pneumonia of unknown etiology was detected at 5 years of follow-up.Conclusion. The data obtained by the authors for the first time in the 5-year prospective study indicate the sufficient and long-term immunogenicity, high efficacy, and safety of PPSV-23 in RA patients treated with DMARDs and BAs. Further clinical trials are needed to clarify the influence of various factors on the efficacy and immunogenicity of PPSV-23 and on the degree of their correlation in patients with RA.Objective: to study the efficacy, immunogenicity, and safety of a 23-valent pneumococcal polysaccharide vaccine (PPSV-23) in patients with rheumatoid arthritis (RA) receiving disease-modifying antirheumatic drugs (DMARDs) and biologic agents (BAs) during a 5-year follow-up.Patients and methods. The investigation included 79 RA patients with a recent history of ≥2 episodes of lower respiratory tract infections (bronchitis, pneumonia). A single dose (0.5 ml) of PPSV-23 was administered subcutaneously during continued methotrexate/leflunomide therapy or 28–30 days before using TNF-α inhibitors. All the patients were followed up during the first year; 39 patients at 24 months (Visit 5), 13 at 36 months (Visit 6), 23 at 48 months (Visit 7), and 18 at 60 months (Visit 8).Results and discussion. RA patients receiving various therapies were noted to have a marked positive immune response to PPSV-23, which was manifested by a significant increase in the postimmunization response coefficient. Vaccination responses were recorded in 61% of the patients with RA. The level of postvaccination responses tended to decrease at the 4-year follow-up. Only one case of community-acquired pneumonia of unknown etiology was detected at 5 years of follow-up.Conclusion. The data obtained by the authors for the first time in the 5-year prospective study indicate the sufficient and long-term immunogenicity, high efficacy, and safety of PPSV-23 in RA patients treated with DMARDs and BAs. Further clinical trials are needed to clarify the influence of various factors on the efficacy and immunogenicity of PPSV-23 and on the degree of their correlation in patients with RA. 

Objective: to identify irreversible organ damages and factors influencing their development and to compare existing musculoskeletal injuries with the activity of systemic lupus erythematosus (SLE).
Patients and methods. The investigation enrolled 197 peri- and postmenopausal female outpatients (mean age, 50.94±9.1 years) with SLE, who were followed up at Clinical Rheumatology Hospital Twenty-Five, Saint Petersburg. The mean disease duration was 9.7±7.5 years. Cytostatic and glucocorticoid (GC) treatment regimens and dosages in the examinees were analyzed on the basis of their primary medical records. The investigators assessed the current disease activity by the SLE Disease Activity Index (SLEDAI-2K) and the Lupus Low Disease Activity State (LLDAS) and irreversible organ damages by the Systemic Lupus International Collaborating Clinics (SLICC) Damage Index (DI).
Results and discussion. 93.4% of the patients continued to receive GS therapy at the time of inclusion in the study. The median GS maintenance dose was 12.5 mg/day. Almost half of the patients (n=86/43.7%) were in menopause (its mean duration was 12.8±7.1 years). Half of the examinees were noted to have remission (n=36/18.3%) or low SLE activity (n=92/46.7%) according to the SLEDAI-2K. Fifty-seven (28.9%) patients met all 5 LLDAS criteria; at the same time other 96 (48.7%) patients met 4 out of the 5 criteria, the 5th criterion being a high GC maintenance dose. High DI scores of ≥4 were found in two thirds (n=131/66.5%) of the examinees. Musculoskeletal system injuries ranked first among other disorders: osteoporosis (OP) and muscle weakness were detected in 76 (38.6%) and 69 (35.0%) patients, respectively. Regression analysis involving all statistically significant factors showed that the degree of damage was influenced by age (p=0.013215), total GS dose (p=0.000047), and previous therapy with cyclophosphamide (p=0.041505).
Conclusion. The contribution of GS therapy to irreversible damage accrual is obvious in peri- and postmenopausal women with SLE. Timely dose adjustment or complete withdrawal of GS during remission in SLE is one of the key factors that substantially reduce the risk of progression of irreversible organ damages due to the prevention of OP and osteoporotic fractures in these patients.

Non-steroidal anti-inflammatory drugs (NSAIDs) can cause undesirable reactions in all parts of the gastrointestinal tract (GIT). However, the frequency of mixed injuries of various GIT parts due to the use of these drugs has not been investigated.
Objective: to estimate the frequency of mixed NSAID-induced injuries of the upper GIT, small and large intestine.
Patients and methods. A total of 112 patients (62.5% were women) (mean age, 56.2±14.6 years) with rheumatic diseases who had regularly taken NSAIDs were examined. All the patients underwent esophagogastroduodenoscopy and video colonoscopy. Video capsule endoscopy was performed in 35 patients with signs of NSAID-induced gastropathy.
Results and discussion. The signs of NSAID-induced gastropathy (gastric and duodenal erosions and/or ulcers) were found in 43.8% of patients; those of NSAID-induced enteropathy (small bowel hemorrhages, erosions, and ulcers) were present in 68.6%; and those of NSAIDinduced colopathy (colonic hemorrhages, erosions, and ulcers) were in 14.3%. The concurrence of NSAID-induced gastro- and colonopathy was present in 28.6% of the patients (odds ratio 12.2; 95% confidence interval, 2.619–56.84); that of NSAID-induced gastro-, entero-, and colopathy was in 10 (20.4% of all the patients with NSAID-induced gastropathy). There was a significant association of the risk of mixed pathology in all GIT parts with the diagnosis of spondylarthritis, the presence of abdominal pain, the signs of dysbiosis and bacterial overgrowth syndrome, as well as with the carriage of CYP2C19 gene polymorphism (the CYP2C19*17*1/*17 allele).
Conclusion. Mixed injury of various GIT parts due to the use of NSAIDs is a frequent and serious pathology that requires comprehensive diagnostic tests and combined use of preventive therapies with different mechanisms of action.

Objective: to analyze the reasons for discontinuation of traditional disease-modifying antirheumatic drugs (tDMARDs), biologic agents (BAs), and tofacitinib (TOFA) in patients with rheumatoid arthritis (RA) in real clinical practice.

Patients and methods. The authors carried out a retrospective analysis of the data of the patients treated with tDMARDs, BAs, and TOFA, who had been included by the physicians of the V.A. Nasonova Research Institute of Rheumatology (RIR) in the all-Russian register of patients with RA (Group 1) in January 1, 2016 to November 1, 2018, the data of a pharmacology history (information about inefficacy (IE) and adverse reactions (ARs) due to the use of tDMARDs and BAs) in RA patients admitted to the V.A. Nasonova RIR during 2011–2016 for high-tech medical care (Group 2).

Results. The main reasons for discontinuation of tDMARDs, BAs, and TOFA were found to be their IE and ARs.

Discussion. 20% of patients with early RA never achieve not only remission, but also minimal disease activity, despite the introduction of current guidelines for its treatment. It is believed that one of the potential causes of resistance to treatment in RA is the IE of traditionally used drugs, which is mediated by transporters (ABCB1 and ABCG2) that reduce their concentrations, causing outflow from the intracellular space. The great importance of these transporters in RA is that their substrates are widely used drugs, such as methotrexate, leflunomide, sulfasalazine, aminoquinoline drugs, and prednisolone. The function of ABCB1 and ABCG2 is shown to be increased in patients with active RA, i.e. the disease activity is closely related to this phenomenon.

Conclusion. IE and ARs are the most common reasons for discontinuation of tDMARDs, BAs, and TOFA in patients with RA; further investigations are needed to clarify their possible mechanisms.

Objective: to analyze the reasons for discontinuation of traditional disease-modifying antirheumatic drugs (tDMARDs), biologic agents (BAs), and tofacitinib (TOFA) in patients with rheumatoid arthritis (RA) in real clinical practice.Patients and methods. The authors carried out a retrospective analysis of the data of the patients treated with tDMARDs, BAs, and TOFA, who had been included by the physicians of the V.A. Nasonova Research Institute of Rheumatology (RIR) in the all-Russian register of patients with RA (Group 1) in January 1, 2016 to November 1, 2018, the data of a pharmacology history (information about inefficacy (IE) and adverse reactions (ARs) due to the use of tDMARDs and BAs) in RA patients admitted to the V.A. Nasonova RIR during 2011–2016 for high-tech medical care (Group 2).Results. The main reasons for discontinuation of tDMARDs, BAs, and TOFA were found to be their IE and ARs.Discussion. 20% of patients with early RA never achieve not only remission, but also minimal disease activity, despite the introduction of current guidelines for its treatment. It is believed that one of the potential causes of resistance to treatment in RA is the IE of traditionally used drugs, which is mediated by transporters (ABCB1 and ABCG2) that reduce their concentrations, causing outflow from the intracellular space. The great importance of these transporters in RA is that their substrates are widely used drugs, such as methotrexate, leflunomide, sulfasalazine, aminoquinoline drugs, and prednisolone. The function of ABCB1 and ABCG2 is shown to be increased in patients with active RA, i.e. the disease activity is closely related to this phenomenon.Conclusion. IE and ARs are the most common reasons for discontinuation of tDMARDs, BAs, and TOFA in patients with RA; further investigations are needed to clarify their possible mechanisms. 

Objective: to evaluate the efficiency of combination therapy with methotrexate (MTX) and hydroxychloroquine (HC) in rheumatoid arthritis (RA) in real clinical practice.

Patients and methods. The investigation enrolled 430 patients with documented RA who had been followed up for 16 weeks by rheumatologists in different regions of the country. Individual schedules were filled out for the patients, by adding demographic, clinical, and laboratory parameters that made it possible to assess the activity of the disease and to estimate the level of glucose, cholesterol, and low-density lipoproteins (LDL). The results of the investigation were evaluated at the inclusion of patients in it and then at 8 and 16 weeks. Taking into account the insufficient previous effect of MTX, the treatment was enhanced by HC.

Results and discussion. By the end of the investigation, the combination therapy with MTX + HC led to significant decreases in the number of swollen and tender joints, the duration of morning stiffness, the severity of pain, and the integrated DAS28 index. The therapy showed a positive effect on the levels of fasting glucose, cholesterol, and LDL. The quality of life improved in patients by Visit 3. The results obtained are in good agreement with the data by foreign and Russian investigators on the greater efficiency of combination therapy with MTX + HC than that of MTX monotherapy and on the pleiotropic (hypolipidemic and hypolipidemic) effect of HC.

Conclusion. It is concluded that in Russian practice when monotherapy with MTX shows an insufficient effect or its high doses cannot be administered to enhance the efficacy of RA therapy, it is possible to use a combination of MTX + HC, especially in older patients with comorbidity (hyperglycemia and hypercholesterolemia).

Management of patients with knee osteoarthritis (OA) in the presence of comorbidity causes significant difficulties associated with the limitations of pharmacotherapy.

Objective: to evaluate the clinical efficacy of ultraphonophoresis with a hyaluronic acid (HA)-containing gel in patients with knee OA complicated by periarthritis.

Patients and methods. The open observational comparative study included 30 patients with a reliable diagnosis of knee OA, who were divided into two groups: 1) 15 patients who had undergone ultraphonophoresis with a HA-containing gel for 10 days (a study group); 2) 15 patients who had received ultraphonophoresis with an intact gel (a control group). To determine the clinical efficiency of HA-containing gel ultraphonophoresis, the investigators conducted a survey of patients and a clinical examination with knee joint palpation to detect synovitis and periarthritis, ultrasonography, and an assessment of initial pain and pain on walking on a 100-mm visual analog scale (VAS) for pain.

Results and discussion. HA-containing gel ultraphonophoresis was found to lead to a significant relief from both pain in the knee joints on walking from 50 [40; 50] to 20 [10; 20] mm (p = 0.0003) and from initial pain from 50 [40; 50] to 10 [0; 10] mm VAS (p = 0.0003). Ultrasonography revealed a reduction or even complete disappearance of the local inflammatory process in the anserine bursa from 5.5 [4.5; 6.4] to 0 [0; 3.0] mm (p = 0.0003). There were no statistically significant pre- and postoperative differences in Group 2 patients.

Conclusion. HA-containing gel ultraphonophoresis in knee OA with periarthritis was shown to contribute to a significant reduction in knee joint pain and to the resolution of periarthritis.

Management of patients with knee osteoarthritis (OA) in the presence of comorbidity causes significant difficulties associated with the limitations of pharmacotherapy.Objective: to evaluate the clinical efficacy of ultraphonophoresis with a hyaluronic acid (HA)-containing gel in patients with knee OA complicated by periarthritis.Patients and methods. The open observational comparative study included 30 patients with a reliable diagnosis of knee OA, who were divided into two groups: 1) 15 patients who had undergone ultraphonophoresis with a HA-containing gel for 10 days (a study group); 2) 15 patients who had received ultraphonophoresis with an intact gel (a control group). To determine the clinical efficiency of HA-containing gel ultraphonophoresis, the investigators conducted a survey of patients and a clinical examination with knee joint palpation to detect synovitis and periarthritis, ultrasonography, and an assessment of initial pain and pain on walking on a 100-mm visual analog scale (VAS) for pain.Results and discussion. HA-containing gel ultraphonophoresis was found to lead to a significant relief from both pain in the knee joints on walking from 50 [40; 50] to 20 [10; 20] mm (p = 0.0003) and from initial pain from 50 [40; 50] to 10 [0; 10] mm VAS (p = 0.0003). Ultrasonography revealed a reduction or even complete disappearance of the local inflammatory process in the anserine bursa from 5.5 [4.5; 6.4] to 0 [0; 3.0] mm (p = 0.0003). There were no statistically significant pre- and postoperative differences in Group 2 patients.Conclusion. HA-containing gel ultraphonophoresis in knee OA with periarthritis was shown to contribute to a significant reduction in knee joint pain and to the resolution of periarthritis. 

Systemic lupus erythematosus (SLE) is one of the most complex rheumatic diseases, which is due to the variety of its clinical forms and manifestations. The article describes a case of severe lung injury (LI) in a female patient with previously undiagnosed and untreated SLE, which led to a fatal outcome. A 33-year-old female patient diagnosed with pneumonia was delivered by an ambulance team to City Clinical Hospital Thirteen. Her leading complaints were dyspnea, joint pain, fever, and abdominal pain. During examination of the patient and analysis of her medical documents, attention was focused on a long history of articular syndrome, recurrent pneumonia with progressive pulmonary hypertension, general trophic, hematological changes, and the presence of autoantibodies, which was in aggregate the basis for the diagnosis of SLE with LI. This clinical case demonstrates the importance of the timely diagnosis and treatment initiation of SLE with LI. The diagnosis of SLE requires special attention to the patient's history and clinical and laboratory parameters. Specific immunological studies were conducted in doubtful cases. Rheumatological alertness is necessary, especially in relation to young women.

Systemic lupus erythematosus (SLE) is an autoimmune systemic inflammatory disease with various clinical manifestations. There are descriptions of overlap syndromes when the signs of several systemic connective tissue diseases, such as rheumatoid arthritis, systemic sclerosis, dermatomyositis, and SjЪgren's syndrome, are simultaneously recorded. Psoriasis belongs to chronic skin diseases of multifactorial genesis, which is determined by genetic, immunological, and environmental factors. About one out of three patients with psoriasis develops psoriatic arthritis (PsA), an inflammatory joint injury. The concurrence of SLE and PsA is rare; there are very few reports on such clinical situations. A special variant of SLE, such as subacute cutaneous lupus erythematosus, can mimic skin lesions in psoriasis, which causes diagnostic difficulties.
The paper gives the data available in the literature on the concurrence of SLE, PsA, and psoriasis. It discusses the specific features of the differential diagnosis of the concurrence of the two nosological entities and its treatment policy. The authors give their own clinical case of the concurrence of SLE and PSA, as well as several descriptions of such cases available in the literature.

Postgenomic analysis of the effects of active ingredients of drugs involves the evaluation of the effects of relevant molecules on the transcription of genes (transcriptomes), on the changes in the activity of proteins (proteomes), and on the activity of molecular cascades (reactomes). The paper gives the results of applying the current chemoinformational approaches to the postgenomic analysis of the effects of glucosamine sulfate (GS). The main result of the investigation is to simultaneously establish the synergistic effect of GS on transcriptomes, proteomes, and reactomes. In particular, GS assists in reducing not only the transcription of genes involved in the NF-κB proinflammatory signaling cascade (NFKB2, TNFRSF1B, PYCARD, TRAF2, TNFSF12, etc.), but also the activity of proteomic proteins that transmit a signal at different levels of the NF-κB cascade (CD44, TLR4, ICAM1, NF-κB, JAK/STAT, etc.). The complex anti-inflammatory effect of GS in reducing the synthesis of proinflammatory cytokines and weakening their effects on the cells is pathogenetic in the treatment of not only osteoarthritis, but also comorbidities accompanied by chronic inflammation.