The majority of systemic immunoinflammatory rheumatic diseases (SARDs — systemic autoimmune rheumatic diseases) have several stages. The most important characteristic of SARDs is pathological activation of B cells and overproduction of organ-specific autoantibodies (auto-Abs), which react with different peptides and cell components and are regarded as biological markers of rheumatic diseases. The main serological markers of SARDs include antinuclear antibodies, rheumatoid factors, anticyclic citrullinatedpeptide antibodies, antiphospholipid antibodies, and antineutrophil cytoplasmic antibodies. Positive tests for these auto-Abs are among the classification criteria for SARDs and are used to evaluate the activity and severity of the diseases, to identify some clinical laboratory subtypes, to predict the development and progression of organ pathology, therapy effectiveness, etc. Moreover, they may serve as predictors of SARD development at a preclinical stage. It has been proved that immunopathological disturbances associated with the loss of immune tolerance to self-antigens and with the initiation of systemic autoimmunity and inflammation develop 5 years on average before the appearance of the first clinical symptoms. Thus, detection of serological markers for SARDs at a preclinical stage, i.e. in the absence of extensive clinical manifestations, makes it possible to use preventive strategies in people at high risk for these diseases.

Using rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis as an example, the paper analyzes the clinical significance of detection of auto-Abs at preclinical or early clinical stages of SARDs when immunopathological disorders have not yet become severe and/or irreversible.

Mixed connective tissue disease (MCTD), also known as Sharp's syndrome, is a rare systemic connective tissue disorder that characterized by a combination of some features of systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, polymyositis with the presence of antibodies to soluble nuclear ribonucleoprotein (anti-U1-RNP) in high titers. The most common clinical manifestations of MCTD include Raynaud's phenomenon, hand edema, muscle weakness, arthralgia/arthritis, and esophageal hypotonia. The course of the disease is mostly benign; however, there are severe cases with damage to the lung, kidneys, cardiovascular system and central nervous system. Poor prognosis and the highest mortality rate are associated with pulmonary hypertension. The diagnosis of MCTD is difficult due to the absence of unified diagnostic criteria and lack of specific manifestations at the onset of the disease. Furthermore, there are no generally accepted guidelines for MCTD treatment.

The paper considers the modern concepts of MCTD, its current diagnostic criteria, clinical and immunological features, and treatment.

The paper deals with international guidelines for the management of antineutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitides (SVs) that are a group of severe life-threatening immune-mediated diseases. This group includes granulomatosis with polyangiitis (Wegener's granulomatosis), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (Churg-Strauss). ANCA-associated SVs (ANCA-SVs) are an important problem of practical rheumatology. The guidelines for the management of ANCA-SV, which were published by the International Group of Experts, which summarize modern scientific achievements and international clinical experience, currently remain the basis for treatment of these diseases.

The use of factor Xa inhibitors is justified in the therapy of thrombosis in antiphospholipid syndrome (APS) and active lupus nephritis (LN). To monitor the efficacy and safety of these drugs, plasma anti-Xa (aXa) activity is determined.

Objective: to assess the aXa activity of selective and non-selective factor Xa inhibitors in patients with systemic lupus erythematosus (SLE) and APS depending on how they affect the kidneys.

Patients and methods. Clinical and laboratory findings were prospectively analyzed in SLE and APS patients who long received low molecular weight heparins (LMWHs) and selective Xa inhibitors, such as fondaparinux and rivaroxaban. The investigation enrolled 70 patients (54 females and 16 males) aged 39 years (range, 31 to 43 years) with SLE (n=15 (21%)), primary APS (PAPS) (n=10 (14%)), and SLE + APS (n=45 (65%)).

Results. Kidney disease was diagnosed in 33 (47%) of the 70 patients. LN was detected in 15 (25%) of the 60 patients: 10 and 5 patients with SLE and SLE + APS, respectively. APS nephropathy (APSN) was manifested by elevated creatinine and urea levels with normal urine sediment and no history of glomerulonephritis and was observed in 18 (33%) of the 55 patients: in 16 with SLE + APS and 2 with PAPS. The therapeutic aXa range of 0.1—1.5 IU/ml was found in 43 (61%) of the 70 patients, low and high aXa activities were seen in 14 (20%) and 13 (19%) patients, respectively.

In patients with APSN, the creatinine clearance (CC) depended on aXa levels: the highest CC was noted in patients with aXa >1.5 IU/mL, the lowest CC was in those with aXa <0.9 IU/ mL (p=0.046). The levels of aXa above the therapeutic range were more common in patients taking fondaparinux (9 (31%) out of the 29 patients) than in those using nadroparin (2 (7%) out of the 29 patients) (odds ratio (OR) 1.92; 95% confidence interval (CI), 1.25—2.97; p=0.04). In the fondaparinux group, high aXa was more frequently observed in patients with high SLE activity (7 (47%) out of the 15 patients) than in those with moderate or mild SLE activity (none out of the 7 patients) (OR 1.88; 95% CI, 1.17—3.01; p=0.037) and was unassociated with LN. The highest aXa level with no signs of hemorrhage was 2.08 IU/mL.

Conclusion. The level of aXa is a qualitative laboratory marker for the efficacy and safety of LMWHs and fondaparinux. In patients with APS, the enhanced aXa activity of LMWHs and fondaparinux was associated with elevated CC and was not accompanied by hemorrhage. Fondaparinux is an effective and safe anticoagulant for the treatment and prevention of thrombosis in SLE and APS. The therapeutic window for aXa should be extended in these patients.

Objective: to evaluate the effect of different biological agents (BAs), including rituximab (RTM) and belimumab (BLM) combination therapy, on B-lymphocyte subpopulations during a follow-up of patients with systemic lupus erythematosus (SLE).

Patients and methods. The investigation enrolled 64 patients with a verified diagnosis of SLE with high and moderate disease activities according to the Systemic Lupus Erythromatosus Disease Activity Index (SLEDAI)-2K scores; 47patients of them took RTM, 10 used BLM, and 7 received RTM + BLM combination therapy. Peripheral blood B-lymphocyte subpopulations were measured by multicolor flow cytofluorom-etry, using a panel of monoclonal antibodies to B-lymphocyte surface membrane markers. The results were assessed using the SLEDAI-2K scores and the British Isles Lupus Assessment Group (BILAG) index.

Results and discussion. RTM therapy led to a marked decrease in major B-lymphocyte populations, the residual cells being naXve B-cells and different memory B cell populations, the percentage of which depended on the degree of depletion after a RTM cycle. Incomplete B-lymphocyte depletion was associated with the large baseline numbers of plasma cells (PCs) (>0.2%). One year after initiation of therapy, the percentage ratio of B-lymphocyte subpopulations returned almost completely to baseline values, except the whole memory B-cellpopulation. BLM therapy resulted in a decrease in PCs and plasmablasts (PBs) to the point of their complete depletion. There were reductions in total CD19+ B-lym-phocytes and naive B lymphocytes. The use of the combination of BAs permitted the monitoring of the total B-lymphocyte population; its slower recovery was seen in patients with its complete depletion after a rituximab cycle. The therapy promoted maintenance of low concentrations of PCs and PBs, total memory B-cell and naive B-cell populations.

Conclusion. In patients with SLE, all the three therapy with BAs demonstrated a good efficiency manifested by a decrease in clinical and laboratory disease activity. The found time course of changes in B-lymphocyte subpopulations can be used for the selection of therapy and for the evaluation of its efficacy.

Objective: to identify the main types of lymphoma with the onset of involvement of the major salivary glands (MSGs), which are encountered in rheumatologic practice, and to evaluate the efficiency of minimally invasive incisional biopsies of the MSGs/lacrimal glands in the diagnosis of different diseases affecting the parotid, submandibular, sublingual, and lacrimal glands.

Patients and methods. A total of339patients (291 women and 48 men) aged 18 to 78 years (median age, 55 years) with MSG involvement were examined at the V.A. Nasonova Research Institute of Rheumatology in 2004 to 2017. Minimally invasive incisional biopsies of the parotid, submandibular salivary (SMSG), and lacrimal glands were carried out to verify the diagnosis.

Results and discussion. Different variants of hematological malignancies with MSG involvement were diagnosed in 187 (55%) patients; nonneoplastic diseases were in 152 (45%) patients. Primary tumors with the onset of MSG involvement were detected in 52 (15.3%) patients. Hematologic malignancies were diagnosed in 32 (61.5%) cases and 20 (38.5%) patients had various benign neoplastic or infectious diseases with MSG involvement. The prevailing hematologic malignances with MSG involvement were non-Hodgkin lymphomas (NHL), indolent MALT-lymphomas in 12 (23%) patients, follicular lymphomas in 6 (11.5%), and AL-amyloidosis affecting the SMSG in 9 (17.3%). The diagnosis was morphologically verified using minimally invasive incisional biopsy of the salivary/lacrimal glands; in all cases, the biopsy was informative for full morphopathological examination and diagnosis verification.

Conclusion. Minimally invasive incisional biopsy of the MSG/lacrimal glands should be actively used in dentistry, rheumatology and blood oncology hospitals for verification of nosological diagnoses when the MSG and lacrimal glands are involved. A sufficient number of tissues obtained using these techniques allows one to abandon severe surgical interventions (partial and complete parotidectomy, SMSG removal, and orbitotomy) currently used for diagnostic purposes in various types of hospitals.

IgG4-related disease (IgG4-RD) is a systemic immune mediated condition that is characterized by the formation of tumor-like fibroinflamma-tory foci in different organs and by the elevation of serum and tissue IgG4 levels in the majority of patients. The pathogenesis of the disease, including the role of IgG4, has not been established exactly. Serum and tissue IgG4 hypersecretion is a nonspecific sign and occurs in many rheumatic, infectious, and malignant diseases.

Objective: to determine the range of nosological entities associated with the increase in serum IgG4 levels, as well as the frequency and nature of this increase in patients with IgG4-RD.

Patients and methods. The results of all serum IgG4 measurements carried out in the Laboratory of Immunology and Molecular Biology of Rheumatic Diseases, V.A. Nasonova Research Institute of Rheumatology, in 2017—2018 were analyzed. Serum IgG4 parameters were separately estimated in 52 patients with verified IgG4-RD according to the universal diagnostic criteria proposed by H. Umehara et al (2011).

Results and discussion. In 2017—2018, a total of247patients were tested for serum IgG4 levels. The latter were elevated in 76 (30.8%) patients, but only 28 (36.8%) were diagnosed as having IgG4-RD. Along with IgG4-RD, antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis, rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) were characterized by increased serum IgG4 levels. The highest median IgG4 level was found in patients with a verified diagnosis of IgG4-RD: 6.31 vs 3.2, 3.22, and 2.69 g/L in ANCA-associated vasculitis, RA, and SLE, respectively.

In 52 patients with IgG4-RD, the IgG4 level >1.35 g/L was found in 88% of cases. The median serum IgG4 level was 3.45 g/L (2.1; 11.4). The highest level was observed in patients with generalized lymphadenopathy and in those with IgG4-related sialoadenitis and dacryoadenitis (Mikulicz disease). The serum IgG4 level was positively correlated with the number of affected organs (Spearman's correlation coefficient, 0.39; p=0.0056, Student's t-test). All the patients showed a tendency towards decreasing serum IgG4 levels during treatment regardless of its clinical response; however, the levels returned to normal only in 73% after 12 months of treatment.

Conclusion. The increased serum and tissue IgG4 concentration is not specific, but at the moment it is the only disease marker available in clinical practice. To correctly interpret the diagnosis, it is necessary to assess the entire set of clinical manifestations, imaging data, and morpholopathological findings.

Objective: to assess the frequency of a reduction in bone mineral density (BMD) and its association with traditional risk factors and clinical parameters in patients with systemic scleroderma (SSD).

Patients and methods. The investigation included 330people: 190 patients (median age 55 [41; 61.5] years) with SSD and 140 control individuals (median age 57 [40.5; 66] years without a history of inflammatory rheumatic diseases. The patients were interviewed using a uniform questionnaire; dual-energy X-ray absorptiometry was used to measure BMD in the lumbar spine (L_i-iv), femoral neck (FN), entire proximal femur (PF), and distal third of the forearm (DTF). The concentration of 25(OH)D was measured in 155 examinees.

Results and discussion. Decreased BMD was found in 69% of patients with SSD and in 58% of controls (p=0.0392), including osteoporosis (OP) in 38 and 31% of cases, respectively. BMD in the L_i-iv and FN was significantly lower in the women with SSD than in the control exam-nees, regardless of age. There was a direct correlation between BMD and body mass index (BMi) and an inverse correlation between BMD and the duration of menopause, that of the disease, and cumulative dose of glucocorticoids (GCs). Among the analyzed clinical factors, there was an inverse correlation between L_i-iv BMD and erythrocyte sedimentation rate (ESR), between BMD in both femoral areas (FN and PF) and C-reactive protein (CRP). The mean concentration of 25(OH)D was 19.83+11.06 ng/mL in the patients with SSD and 23.29+8.61 ng/mL in the controls; normal vitamin D levels were detected in 9% of the patients with SSD and 24% of the controls (p<0.05).

Conclusion. Low BMD was found in 69% of patients with SSD, including in those with OP (38%). Most (91%) patients had vitamin D deficiency. BMD correlated with traditional risk factors: positively with BMi and negatively with age and menopause duration. The clinical factors were found to be association with disease duration and cumulative GC dose.

Many patients with osteoarthritis (OA) tend to have comorbidities. This tendency is more frequently observed to increase with age. One of the comorbidities is type 2 diabetes mellitus (T2DM). Due to the higher prevalence of coexistence of these two conditions, it has been suggested that T2DM-associated hyperglycemia may adversely affect joint tissues and increase OA severity. However, the molecular mechanisms in the development of DM in patients with OA remain unclear.

Objective: to trace the dynamics of T2DM development in patients with OA at the level of the expression of genes associated with glucose metabolism, joint destruction, and general regulation of metabolic processes.

Patients and methods. Three patients with OA were followed up for 4—6 years, including the year of onset of T2DM. The clinical condition of the patients was analyzed once a year. Total RNA was annually isolated from their blood and used to determine the level of gene expression by real-time polymerase chain reaction.

Results and discussion. The development of T2DM was shown to be accompanied by the increased expression of genes related to glycolysis, Krebs cycle, pentose phosphate pathway, matrix metalloproteinases and regulators of AMPKand mTOR metabolism. By contrast, the level of the hypoxia regulator HIF1a and hexosamine pathway genes was decreased.

Conclusion. The occurrence of T2DM in the presence of OA is likely to be associated with the higher needs for cells for ATP energy and is accompanied by activation of the glucose assimilation pathways, as well as by the increased expression of the genes responsible for extracellular matrix destruction. This may be caused by impaired protein glycosylation due to inhibition of the hexosamine pathway.

Objective: to study the impact of the diagnosis of ankylosing spondylitis (AS) on the planning of pregnancy by patients and their attitude towards the use of drugs during gestation and to assess the competency of physicians in the issues relating to pregnancy in AS.

Patients and methods. The data of three studies based on the questionnaire surveys of female AS patients and rheumatologists.

Results and discussion. The questionnaire survey revealed a decline in the number of pregnancies per woman after the onset of AS. Having learned about their diagnosis, 70% of patients reported a change in their maternity plans; however, most (80%) women said that they were still going to become pregnant, but they would constantly feel discomfort and fear for their own health and the health of their future child. Pregnancy was rejected due to AS development by 13.9% of patients, regardless of the presence or absence of children born in the healthy period of their life. Only 50% of women discussed the issues relating to pregnancy with a rheumatologist, and one third of them did not obtain the necessary information. Only one fourth of patients were ready to continue treatment for AS in the period of preparation for conception and during gestation.

On the whole, Russian rheumatologists have enough knowledge about pregnancy outcomes in AS, and, in particular, about the factors which may influence the favorable outcome and about the fundamentals of follow-up for pregnant women. At the same time, 18% of rheumatologists expect increased AS activity during gestation, more than two thirds consider sacroiliitis to be an indication for surgical delivery, and 30% are ready to discontinue the drugs which are permitted for use before pregnancy.

Conclusion. Lack of information about the planning and course of pregnancy in AS, the risk of disease exacerbation and the safety of therapy during gestation is noted in both patients and rheumatologists. It is necessary to implement educational measures on the problem of pregnancy in AS for rheumatologists and women of fertile age and their family members.

Despite the existing guidelines for the management of gout and its potential reversibility, the quality of patient management in general therapy practice remains a serious issue.

Objective: to assess the current state of management of patients with gout in real clinical practice.

Patients and methods. The first stage of the study included an interview with 97 physicians grouped according to their specialties: rheumatologists, general practitioners, and others. The second stage involved an interview with 64 patients with gout who were followed up by physicians of different specialties.

Results and discussion. Physicians most frequently used nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, glucocorticoids (GCs), and allopurinol. Urate-lowering drugs were prescribed mostly by rheumatologists and more rarely by other specialists. The most commonly used drug was allopurinol at a maximum dose 300 mg/day. There was a tendency to a decrease in the number of tophi in the patients who were treated according to the EULAR (European League Against Rheumatism) guidelines. The patients of this group also had lower levels of uric acid (UA) and were more highly adherent to therapy.

The predominant use of NSAIDs in the rare administration of colchicine and GCs, as well as the use of allopurinol to relieve an acute gout attack creates prerequisites for aggravating the disease and decreasing patient compliance. The insufficient dose of allopurinol and no use of prophylactic colchicine for chronic gout contribute to the progression of the disease and the development of its acute attacks. Following the EULAR guidelines makes it possible to achieve the target levels of UA and not only prevent, but also to ensure the regression of gout manifestations, such as tophi.

The paper describes a clinical case of a female patient with bacterial sialadenitis. The specific features of this case are sialadenitis concurrent with serum monoclonal secretion, as well as the absence of the effect of previous antibacterial therapy. The author describes basic directions in the differential diagnosis of sialadenitis, which requires that rheumatic, granulomatous, and tumor diseases should be ruled out.

The basis of the clinical picture of adult-onset Still's disease is a triad of symptoms, includingfever, arthralgia/arthritis, and characteristic rash called «Still rash». The first line of therapy includes glucocorticoids, synthetic disease-modifying anti-rheumatic drugs; biological agents, such as tumor necrosis factor a inhibitors and interleukin-6 and interleukin-1 inhibitors, are used in standard therapy-resistant cases.

Idiopathic inflammatory myopathies (IIMs) are a group of autoimmune diseases characterized by cross-striated muscle inflammation accompanied by muscle weakness. The rarity of these diseases and a large number of other diseases with similar clinical presentation, along with the absence of simple laboratory tests for confirming the diagnosis of IIMs can cause diagnostic difficulties. The latter may particularly frequently occur in the differentiation of polymyositis from sporadic inclusion body myositis, and late-onset limb-girdle muscular dystrophies. Magnetic resonance imaging of the thigh and leg muscles is of great importance for the differential diagnosis of myopathies, including autoimmune ones.

In a number of cases, systemic therapy for rheumatoid arthritis (RA), including disease-modifying anti-rheumatic drugs, biological agents, glucocorticoids (GCs), and nonsteroidal anti-inflammatory drugs, fails to completely suppress joint inflammatory changes in the patients. Therefore, local methods are widely used in the combination therapy of RA. Intra-articular injection of hyaluronic acid (HA) is a highly local treatment modality. HA can be used as initial therapy when it is necessary to achieve rapid clinical improvement, or at a later stage of the disease, in exacerbation of arthritis. However, in some patients the effect of intra-articular HA can be short-lasting, and a favorable result can be obtained with local radiotherapy. It is based on powerful irradiation of the inflamed synovium, which is provided by intra-articular injection of radioactive isotope colloids. In Russia, RA was successfully treated with colloidal Au-198, but its production was ceased in the 1990s, and agents for radioisotope synovectomy have been long unavailable.

Tungsten-188/Rhenium-188generator has been recently designed in Russia, which allows Rhenium-188 to be obtained in clinics. Preclinical trials have shown that intra-articular injection ensures good fixation of the drug in the knee joint with its insignificant accumulation in the liver and other non-target organs and tissues. Introduction of this drug into routine clinical practice can markedly improve the efficiency of treatment in patients with chronic arthritis.

The international multicenter PRECISION study evaluating the cardiovascular safety of celecoxib, naproxen, and ibuprofen is under close scrutiny by critics. One of the criticisms about this study was that the use of relatively low dose (on average just above 200 mg/day) may not be effective enough. But is it really so?

This review gives data from numerous international studies dealing with the treatment of osteoarthritis (OA), in which celecoxib 200 mg/day is compared with paracetamol 4000 mg/day, diclofenac 100—150 mg/day, naproxen 1000 mg/day, ibuprofen 2400 mg/day and slow-acting antirheumatic drugs (glucosamine, chondroitin, and their combination). Almost all studies demonstrate that celecoxib 200 mg has a good and rapid analgesic effect that is not inferior to or exceed that of the reference drugs.

Celecoxib 200 mg/day could relieve pain in OA for many months and prevent disease recurrences. The low risk of gastrointestinal and cardiovascular complications, which has been confirmed by the PRECISION study, makes celecoxib 200 mg/day the drug of choice for long-term OA therapy, including in patients with serious comorbid conditions.

The review presents modern concepts of the role of xanthine oxidase (XO) in the pathogenesis of a number of diseases. It has been shown that XO activity can be associated with the development and progression not only of gout, but, possibly, diabetes mellitus, hypertension, and other cardiovascular diseases.

The paradigm of an association of hyperuricemia (HU) with cardiovascular and chronic renal diseases has undergone certain changes — from skepticism to obtaining the evidence of its serious negative impact. Moreover, XO has been established to be a key enzyme involved in the synthesis of uric acid (UA) as a final adenine nucleotides metabolite, and is extensively present in various organs (the liver, intestine, lung, kidneys, heart, and brain) and in plasma. XO plays an important role in the synthesis not only of UA, but also in that of superoxide free radicals. There are two possible mechanisms linking metabolism and inflammation, in which UA is involved: inflammation activated by UA crystallization and generation of superoxide free radicals during its synthesis. The role of reactive oxygen species is discussed in a number of pathological conditions: induction of apoptosis/necrosis, inhibition of expression of many genes, activation of cell signaling cascades, oxidative damage to DNA and lipids, inflammation, metabolic disorders, atherosclerosis, etc. Inhibition of these mechanisms leads to a decrease in the synthesis and accumulation of UA in the bones, joints and other tissues. Accordingly, XO is a confirmed target for the treatment of gout, and, possibly, other HU-associated conditions. After introduction of a new XO inhibitor (iXO) into clinical practice, the target level of UA has can be achieved by more than 80% of patients with gout. So there is a growing interest in the assessment of the potentials of iXO for the treatment of different pathological conditions.

The chief complaint of patients with rheumatoid arthritis (RA) is pain. The latter is one of the main signs of chronic inflammation, which holds a central position in the clinical picture of the disease. Pain is not among the baseline parameters that are used to calculate total disease activity indices. Nevertheless, pain greatly influences the result of RA activity determination using the total indices. However, this assessment system can take into account only the intensity of pain, whereas the clinical significance of pain syndrome is largely determined by its nature. The causes of pain in RA can be different in different patients and even in one patient at early and late stages of the disease, during the periods of exacerbation and attenuation of the inflammatory activity.

Pain in RA is not always associated with the active inflammatory process. At the same time, intense non-inflammatory pain can significantly affect the traditional indicators of inflammatory activity, by distorting the result of quantitative determination of disease activity. In turn, an erroneous activity assessment may cause an incorrect choice of treatment policy. Therefore, the clinical use of tools that reliably determine the nature of pain, can contribute to a significant improvement in the quality of care for RA patients.

In most cases pain in RA is associated with inflammatory changes in joints or periarticular soft tissues. Therefore along with disease-modifying anti-rheumatic drugs, nonstreroidal anti-inflammatory drugs (NSAIDs) are widely used in the combination therapy of RA. However, their use is limited by a risk of adverse reactions. Etoricoxib is one of the highly effective drugs with a good safety profile. Currently, there are no recommendations for the treatment of neuropathic pain in patients with RA. Investigating the efficacy of tricyclic antidepressants and cannabinoids in RA has failed to prove their advantages over placebo.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most effective medications in modern pharmacotherapy. At the same time, it has been established that NSAIDs can cause cardiovascular diseases. Glucosamine sulfate (GS) is used in the therapy of osteoarthritis and, according to experimental data; it can exert an antithrombotic effect. This paper evaluates the antithrombotic effects of GS and a number of NSAIDs (such as, acetylsalicylic acid (ASA), dexketoprofen, diclofenac, and meloxicam) through chemoreactome analysis. It has been found that the antithrombotic effects of GS can be on average only 1.5—3 times weaker than those of the NSAIDs studied. The findings may suggest that GS can enhance the antithrombotic effect of ASA, in particular in the presence of cardiovascular disease in patients with osteoarthritis.