A clinical case of a patient with axial spondyloarthritis (AxSpA) and chronic recurrent skin lesions in the form of acne conglobata, suppurative hydradenitis and the formation of fistulous tracts is presented. On the example of clinical observation, a diagnostic search was described, which included suppurative hydradenitis, SAPHO syndrome: synovitis, acne, pustulosis, hyperostosis, PASS syndrome: pyoderma gangrenosum, acne, ankylosing spondylitis, suppurative hydradenitis and the selection of therapy is argued. The possibilities of using biologic drugs in patients with AxSpA and concomitant autoinflammatory skin processes are described.

The mechanism of development of osteoporosis (OP) in systemic scleroderma (SSc), despite ongoing studies on this subject, remains not completely clear.

Objective. To assess the state of bone mineral density (BMD) in patients with systemic scleroderma (SSc) and to determine the level of bone metabolism markers (osteocalcin, b-CrossLaps) in blood serum.

Methodology. We examined 65 patients with SSc: 6 (9%) men and 59 (91%) women, with an average age of 51 [39;61] years and 35 relatively healthy individuals comparable in basic anthropometric parameters with patients of the main group. The main population risk factors for osteoporosis were assessed. Bone mineral density (BMD) was assessed using dual energy X-ray absorptiometry (DXA). The level of vitamin D, osteocalcin (OC), and b-CrossLaps in blood serum was determined by enzyme immunoassay.

Results. A decrease in BMD was significantly more often observed in patients with SSc - 46 (71%) than in controls - 11 (31%). Significant risk factors for OP in SSc were the presence of menopause that occurred at an early age, low physical activity, hypovitaminosis D, probably high activity and duration of the disease. In patients with SSc, there was a significant decrease in the level of OK compared with the control; in the presence of a decrease in the BMD, the content of OK was significantly lower than with a normal BMD. Mean values ​​of b-CrossLaps in SSc were comparable with the control; in patients with OP, the parameter was lower than in those with normal BMD.

Conclusion. OP develops significantly more often in SSc compared to the control. Risk factors for OP are early menopause, low physical activity, duration and activity of SSc. The predominance of bone formation disorders to a greater extent than bone resorption as a mechanism for the development of secondary OP was noted.

Objective: Olokizumab (OKZ) is one of the innovative biologic treatments for rheumatoid arthritis (RA) targeting interleukin-6 (IL-6). The study purpose was to evaluate the 24-week efficacy and safety of OKZ in routine clinical practice among RA patients in Kazakhstan, filling a gap in existing research focusing on Western populations.

Materials and methods: A 24-week, single-center, observational study. A total of 26 RA patients with moderate to high disease activity (by DAS28) despite methotrexate therapy received olokizumab 64 mg subcutaneously (every 4 weeks) combined with methotrexate. Disease activity (DAS28-CRP) was evaluated at baseline, at week 4, week 12 and at week 24.

Results and discussion: 88% of patients were female, all were seropositive with median age of 53 years (range 24–73), and mean DAS28-CRP 5.5 ± 1.3. At week 24, a EULAR good and moderate response was observed in 19 (73.0%) patients. Significant improvements were noted from baseline DAS28-CRP by week 12 and week 24 (p<0.05). Remission rate (based on DAS28-CRP) was 50.0% (figure 2).  Olokizumab was generally well tolerated, with no unexpected safety findings.

Conclusion: This real-world study confirmed efficacy and safety of olokizumab in line with previous RCT results in a predominantly Asian RA population, supporting its adoption in routine clinical management of RA as an effective and well-tolerated treatment option. 

Objective: to study the possible relationship between genetic, clinical, laboratory, demographic data and the average level of pain postoperatively, the need for opioid analgesics in patients who underwent total knee or hip arthroplasty.

Materials and methods. The study included 61 patients who underwent total knee or hip arthroplasty. Patients were prescribed NSAIDs (ketoprofen or ketorolac) postoperatively, tramadol was prescribed as needed. A numeric rating scale was used to assess pain during the first 5 days after surgery; opioid analgesics (morphine equivalents) consumption during the hospitalization was recorded. CYP2C9, CYP2C8, PTGS1, PTGS2, ABCB1, CYP2D6, OPRM1, COMT, and C3orf20 gene polymorphisms were determined by real-time PCR.

Results and discussion. Patients with AС genotype of CYP2C9*3 had less severe pain on day 1 (4.5±1.0 versus 7.0±2.3 points, p=0.03), and had a lower need for opioids (20.0±11.5 versus 28.0±7.4 units of morphine equivalent, p=0.04) during the hospitalization than AA genotype carriers. Patients with CC genotype of ABCB1 rs1045642 had lower pain on day 5 compared with CT genotype carriers (1.5±0.7 vs. 3.7±1.2, p=0.04). Patients with AA genotype of OPRM1 rs1799971 required more opioids postoperatively than patients with AG+GG genotypes (21.6±9.8 vs. 28.4±7.1, p=0.03). Patients with GG genotype of C3orf20 rs12496846 had more severe pain on day 4 (6.0 ± 1.41) compared with patients with AA genotype (2.60 ± 1.50), p=0.002.

Conclusion. The intensity of postoperative pain and/or the opioid analgesics consumed after knee or hip arthroplasty were associated with pharmacogenetic features of patients, namely CYP2C9, ABCB1, OPRM1, C3orf20 genotypes.