Osteoarthritis (OA) is the most common disease of the elderly, which is accompanied by pain and damages all tissues of the joint. OA is associated with progressive loss of articular cartilage, sclerotic changes in the subchondral bone and the formation of osteophytes. Cartilage destruction is caused by resorption of the extracellular matrix, which consists mainly of type II collagen and aggrecan proteoglycan. Excessive cleavage of type II collagen in OA is associated with increased synthesis and activity of metalloproteinases and the expression of pro-inflammatory cytokines of interleukin 1β and tumor necrosis factor α. Currently, OA therapy is symptomatic, often ineffective, and in some cases is accompanied by adverse side effects. Therefore, the search for new therapeutic approaches to the treatment of the disease, using modern technological capabilities and knowledge of the metabolic disorders that cause the disease. The review presents new promising methods in the treatment of OA using stem cells and subcellular structures, based on modern knowledge of molecular and cellular mechanisms that are disrupted during development and disease progression.

Levilimab is anti-interleukin-6 receptor (IL6R) monoclonal antibody. The article presents data obtained during 24 weeks of the SOLAR phase III study.
Objective: to confirm efficacy and safety of levilimab in combination with methotrexate (MTX) in patients with methotrexate resistant active rheumatoid arthritis (RA).
Patients and methods. 154 adult patients, aged ≥18 years with the diagnosis of RA (ACR/EULAR 2010) and confirmed disease activity at screening despite treatment with MTX for at least 12 weeks (in a stable dose 15-25 mg/week). Patients were randomized 2:1 in levilimab (162 mg once a week, subcutaneously) + MTX (n=102) or placebo + MTX (n=52) group.
The hypothesis of superiority of levilimab over placebo was tested for two co-primary efficacy endpoints: proportion of subjects who achieved ACR20 at week 12 and proportion of subjects who achieved low disease activity (LDA) of RA (DAS28-CRP <3.2) at week 24. Safety was assessed through monitoring of adverse events (AEs).
Results and discussion. Seventy (68.6%) subjects who received levilimab and 20 (38.5%) who received placebo achieved ACR20 response at week 12. Fifty three (52%) subjects who received levilimab and 3 (5,8%) subjects who received placebo achieved LDA at week 24. The most common adverse events (reported in ≥5% of subjects) in levilimab and placebo arms, respectively were (by decreasing frequency): blood c holesterol increase (24% vs 12%), alanine aminotransferase elevation (11% vs 8%), lymphocyte count decrease (9% vs 8%), blood total bilirubin increase (11% vs 0%), blood triglycerides increase (10% vs 2%), aspartate aminotransferase elevation (7% vs 4%), positive interferon-gamma release assay (IGRA) with M.tuberculosis antigen blood test (5% vs 6%), absolute neutrophil count decrease (8% vs 0%). No deaths were occurred.
Conclusion. The study confirmed superior efficacy of levilimab + MTX over placebo + MTX in subjects with MTX resistant active RA. Levilimab showed favorable safety profile and low immunogenicity. No new important safety risks were detected.

Objective: to assess the frequency of prescription, efficacy and tolerability of biological disease-modifying antirheumatic drugs (bDMARDs) therapy in patients with major monogenic autoinflammatory diseases (mAID) according to the Federal Rheumatology Center clinical practice. 
Patients and methods. From 2008 to 2020 years, 158 patients with mAID were included in the study, 53 of whom were prescribed bDMARDs: 12 patients had Familial Mediterranean Fever (FMF); 26 – Cryopyrin-Associated Periodic Syndromes (CAPS), including 21 patients with MuckleWells Syndrome (MWS) and 5 – with Chronic Infantile Onset Neurologic Cutaneous Articular / Neonatal Onset Multisystem Inflammatory Disease (CINCA/NOMID), 12 patients had Tumor necrosis factor (TNF) receptor-Associated Periodic Fever Syndrome (TRAPS) and 3 – Hyper-Immunoglobulinemia D-syndrome (HIDS/MKD). Among all these patients 25 were male and 28 female, aged 1.5 to 44 years, 45 were children (under 18) and 8 adults. Interleukin 1 inhibitors (iIL1) were prescribed in accordance with the following scheme: canakinumab – subcutaneously 2–5 mg/kg or 150 mg per injection, every 4–8 weeks; anakinra – subcutaneously 1–5 mg/kg or 100 mg/day, daily. Etanercept (ETC) was injected subcutaneously 0.4–0.8 mg/kg 1–2 times a week, and adalimumab (ADA) was injected subcutaneously 20–40 mg once every 2 weeks. Tocilizumab (TCZ) was administered intravenously, 8–12 mg/kg once every 2–4 weeks. The duration of the disease at the time of treatment initiation ranged from 1 to 44 years. The duration of bDMARDs therapy in patients with mAID ranged from 1 month to 12 years.
Results and discussion. From 158 patients with mAID, in 53 (33.5%) bDMARDs were administered. They were used more often in patients with CAPS (56.6%), and less often – in TRAPS (26.4%), FMF (28.3%) and HIDS/MKD (5.7%). iIL1 were the most frequently prescribed bDMARDs (90.6%): canakinumab (in 38 patients) and anakinra (in 10), they were mainly used in patients with CAPS, in 2/3 of patients with TRAPS, HIDS/MKD and colchicine-resistant FMF. During the first days of iIL1 treatment, all patients with mAID showed a statistically significant clinical improvement: normalization of general condition, emotional recovery, relief of fever, disappearance of rash, decrease in the severity of lymphadenopathy and hepatosplenomegaly, relief or significant positive dynamics of eye symptoms, subjective improvement in hearing and audiogram (with dynamic control in patients with CAPS), decrease in the level of acute phase markers (in all cases). In 7 patients with CAPS, who received anakinra, after a positive response was achieved, switching to canakinumab was performed, which maintained the full effectiveness of therapy. TCZ (in 7 patients) and inhibitors of tumor necrosis factor α (iTNFα) – ADA (in 3) and ETC (in 4), – were used less frequently. iTNFα were more often prescribed to FMF patients with a complete response to treatment. Tolerability of bDMARD therapy was satisfactory in all patients.
Conclusion. Currently, iIL1 are the first line of therapy among biological agents for mAID, especially in patients with CAPS. If they are ineffective or intolerant in certain situations, alternative bDMARDs (iTNFα and IL6 inhibitors) can also be used, but this issue needs further study.

Objective: to study the clinical and laboratory features of erythema nodosum (EN) in a cohort of patients with COVID-19 referred to a rheumatological center.
Patients and methods. During 2020–2021 years 21 patients (18 women and 3 men, mean age 43.2±11.4 years) with EN and polyarthralgia/arthritis were examined. Depending on the time of EN and articular syndrome associated with COVID-19 development, patients were divided into three groups: 1) up to 4 weeks – acute COVID (symptoms potentially associated with infection); 2) from 4 to 12 weeks – ongoing symptomatic COVID and 3) more than 12 weeks – post-COVID syndrome (persistent symptoms not associated with an alternative diagnosis). All patients underwent a comprehensive clinical, laboratory and instrumental examination, including ultrasound of the joints and chest computed tomography (CT), as well as pathomorphological examination of skin and subcutaneous adipose tissue from the site of the node (in 9 cases).
Results and discussion. Based on the anamnesis data, COVID-19 in the study cohort had mild (in 13 patients) and moderate (in 8) severity. Two patients (21 years old and 23 years old) with mild severity of the disease noted red painful (45 mm on the visual analogue scale of pain) nodes on the legs and polyarthralgia for the first time on the 2nd – 3rd day from respiratory symptoms onset. In 9 (52.3%) patients, mainly with a mild course, similar skin changes were detected 24.5±7.6 days after active COVID-19 relieve, i.e. during the period of ongoing symptomatic COVID. In 8 (38%) patients, including 6 with moderate severity of the disease, the appearance of nodes was noted after 85.6±12.3 days, which corresponded to the post-COVID syndrome.
At the time of examination, complaints of skin rashes and joint pain were reported in 100 and 71.4% of patients, respectively. 67% of patients had shortness of breath, weakness, cough, sweating and myalgia. Subfebrile fever had 5 (24%) patients, mainly with ongoing symptomatic COVID (3 patients). In the overwhelming majority of cases (86%), EN was located on the anterior and lateral surfaces of shins, less often on the posterior and medial surfaces. It is noteworthy that the affection of more than 50% of the surface of the lower and upper extremities was associated with the number of nodes (p<0.02), the level of CRP (p<0.03) and the presence of post-COVID syndrome (p<0.2). Fifteen (71.4%) patients had arthralgias, mainly of ankle (80%) and knee (53.3%) joints.
Laboratory abnormalities included: median ESR was 34 [12; 49] mm/h, CRP level – 9 [2; 32] mg/l. The results of the polymerase chain reaction for SARS-CoV-2 were negative in all patients. In 100% of cases IgG antibodies to SARS-CoV-2 were detected and in 52.3% – IgM antibodies. On chest CT 5% lung affection was detected in 43% of patients, 5–25% lesion in 57.1% of patients, 8 (38%) of whom were with post-COVID syndrome. Pathomorphological examination of the nodes showed signs of septal panniculitis.
Conclusion. When EN, associated with SARS-CoV-2 appears it is important to suspect a post-infectious manifestation in time, based on the clinical picture of the disease and to determine the scope of further examination and adequate treatment.

Ineffectiveness of interleukin 6 inhibitors (iIL6), tocilizumab (TCZ) and sarilimumab in ankylosing spondylitis (AS) was shown in randomized clinical trials. However, there is ample evidence that IL6 is actively involved in the pathogenesis of this disease. In addition, the efficacy of iIL6 in patients with secondary AA-amyloidosis was established.
Objective: to analyze the results of TCZ administration in AS, complicated by secondary AA-amyloidosis.
Patients and methods. The analysis included 6 patients with AS with secondary AA-amyloidosis. All patients were HLA-B27 positive male. The average age of patients was 44±9.2 years, the average age of the disease onset was 16.3±7.9 years, the average duration of AS was 26.0±7.5 years. All 6 patients had pathomorphologic confirmed secondary AA-amyloidosis: all had kidney affection, 5 patients also had gastrointestinal tract affection and 2 had heart affection. As a first biological drug TCZ was prescribed in 2 patients, and 4 patients had previously received one or more inhibitors of tumor necrosis factor α. The average duration of TCZ treatment was 27.6 [3.0; 36.0] months.
Results and discussion. During TCZ therapy, the level of CRP (M±σ) significantly decreased: from 81.1±74.5 to 1.2±0.8 mg/L (p<0.05), as well as daily proteinuria (Me [25th ; 75th percentile]): from 1.8 [1.0; 2.1] to 0.2 [0.1; 0.3] g/day (p<0.05) and AS activity indices – BASDAI (M±σ): from 6.2±1.6 to 3.3±0.9 (p<0.05 ); ASDAS-CRP (M±σ) from 4.6±1.1 to 2.04±0.7 (p<0.05). Positive dynamics was also noted in relation to a decrease in the number of patients with inflammatory back pain, arthritis and coxitis. A case of clinical and laboratory remission of AS on TCZ treatment is described. 
Conclusion. The presented data show that in certain clinical situations iIL6 can be highly effective in AS.

Patient's satisfaction with treatment is a fundamental indicator of the quality of medical care, which is especially important for assessing the effectiveness of therapy for musculoskeletal pain in rheumatic diseases (RD).
Objective: to determine satisfaction of patients with RD with pain relief therapy and to analyze the factors influencing the subjective assessment of analgesic therapy.
Patients and methods. Anonymous survey of 1040 patients (age 55.8±14.0 years, 76.8% were women) with RD, rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthritis, systemic connective tissue diseases and gout, was carried out. The presence of pain and its therapy, satisfaction with treatment, and patient's opinion about the reasons of low pain relief effectiveness were assessed. The dependence of the presence of dissatisfaction with treatment on a number of demographic and clinical factors was analyzed.
Results and discussion. 71.5% of patients experienced pain in one or more joint areas and/or in the back. 70.6% of patients used non-steroidal antiinflammatory drugs (NSAIDs), 1.6% – paracetamol, 40.0% – non-drug modalities and methods of alternative medicine. 15.6% of the respondents were completely satisfied with the treatment, 64.0% were partially satisfied, and 20.4% were completely dissatisfied. The main subjective reasons for the insufficient effectiveness of analgesic therapy were: fear of taking prescribed medications due to possible complications (45.4%), low effectiveness of drugs (15.7%), insufficient attention of doctors (20.3%). Male gender, body mass index >30 kg/m2 , severe pain, pain in several areas, and the diagnosis of OA were statistically significantly associated with treatment dissatisfaction. In contrast, patients with RA showed greater satisfaction with treatment.
Conclusion. Most patients with RD are dissatisfied with the results of pain therapy. Educational work with patients and a personalized approach to prescribing analgesic therapy is needed.

Objective: to investigate the efficacy and safety of low-dose colchicine in patients with gout receiving urate-lowering therapy (ULT).
Patients and methods. A single-center prospective study included 113 patients with gout. The main group consisted of 92 patients who were prescribed colchicine 0.5 mg/day combined with ULT (allopurinol or febuxostat), control group – 21 patients with contraindications to colchicine therapy who received only ULT. Patient data were entered into individual registration cards at the first visit, as well as on the 90th and 180th day after the start of drug intake. The presence of arthritis attacks was recorded by doctor or patient using a validated questionnaire. We compared the mean frequency of arthritis attacks in the groups, their duration and maximum pain intensity according to the visual analogue scale (VAS). Laboratory tests included: complete blood count test, general urinary test, uric acid (UA), blood glucose, alanine aminotransferase, aspartate aminotransferase, creatinine, serum creatine phosphokinase.
Results and discussion. Patients who did not receive prophylactic anti-inflammatory therapy had significantly longer duration of the disease and higher number of affected joints. For 6 months of follow-up, there were no arthritis attacks in 54% of patients who were prescribed colchicine, and only in 19% of patients who did not use prophylactic anti-inflammatory therapy (p=0.004). The duration of arthritis attacks and the intensity of pain according to the VAS were also statistically significantly lower in the colchicine group (p<0.031 and p<0.01, respectively). Due to the development of adverse events, related to colchicine therapy, only 3 were excluded from the study. The mean serum UA level by the end of the study in colchicine group did not differ from that in the control group.
Conclusion. Administration of colchicine, 0.5 mg/dai for 6 months after initiation of ULT is safe and can reduce the frequency and severity of arthritis attacks.

Objective: to evaluate the efficacy and safety of Alflutop therapy in elderly patients (75–90 years old) with knee osteoarthritis (OA) and multimorbidity based on the results of a prospective 6-year follow-up.
Patients and methods. The study included 38 elderly women with knee OA (according to ACR criteria, 1986) stage II–III by Kellgren–Lawrence grading system, with pain ≥40 mm by visual analogue scale (VAS), who needed to take non-steroidal anti-inflammatory drugs (NSAIDs). Alflutop was administered as 1 ml intramuscular injections 20 consecutive days with a 6-month interval (12 courses). The effectiveness of therapy was assessed by VAS, WOMAC index and EQ-5D questionnaire. The safety of therapy was monitored throughout the observation period. The duration of the study was 6 years.
Results and discussion. The full course of treatment with Alflutop was completed by 29 (76.3%) patients. Nine (23.7%) patients discontinued the study due to their inability to visit the treatment center (for reasons unrelated to the study).
In elderly patients with knee OA, high level of multimorbidity was revealed, 5 comorbidities on average.
There was a significant decrease in pain according to VAS (≥20%): by visit (V) 1 – in 76.3%, by V2 – in 71.0%, by V3 – in 68.4%, by V4 – in 63.1% and by V5 – in 55.2% of patients. By the 21st day of Alflutop therapy, a statistically significant decrease in the total WOMAC index (p<0.001) and an improvement in the quality of life according to the EQ-5D questionnaire (p=0.016) were found. These indicators remained relatively stable throughout the follow-up. By the 12th month, a decrease of the need of NSAIDs was registered (p=0.005).
X-ray progression of OA stage ≥1 according to Kellgren–Lawrence on Alflutop therapy after 36 months of observation was recorded in 10.5% of patients, after 72 months – in 50.0%. No serious adverse events were registered during entire observation period.
Conclusion. The results of a 6-year prospective study demonstrate the high efficacy of Alflutop in elderly patients with knee OA. The obtained data confirm the safety of long-term treatment with this drug in elderly patients with high multimorbidity, which makes it the first-line drug in the complex therapy of OA.

Objectives: evaluation of the clinical efficacy and safety of the healthy joints maintaining compound Artroflex^® in knee osteoarthritis (OA) in postmenopausal overweight women in outpatient clinical practice.
Patients and methods. An open, prospective observational single-center post-marketing study included 30 postmenopausal women 50–75 years old (mean age 62.3±6.3 years) with knee OA. Patient body mass index (BMI) was >25 (mean body weight 85.3±15.3 kg). Radiographically confirmed primary gonarthrosis stage II according to Kellgren–Lawrence was detected in 26 (87.0%) patients, stage III – in 4 (13.0%). The duration of knee OA ranged from 1 to 21 years (average 7.8±6.1 years).
Artroflex^® was prescribed 1 capsule 2 times a day for 3 months. During three visits (baseline, after 1 and 3 months), the need for analgesics or non-steroidal anti-inflammatory drugs (NSAIDs) and the occurrence of adverse reactions (AR) were determined. Health status and pain level were also assessed using a visual analogue scale (VAS), the severity of pain and stiffness, limited function according to the WOMAC questionnaire, fatigue/fatigue according to the FACIT scale, the Charlson comorbidity index, satisfaction of the doctor with the results of treatment using the IMOS scale, and satisfaction of the patient with using the IMPSS scale.
Results and discussion. A statistically significant decrease in the pain score according to the VAS, an improvement in health status, and the WOMAC index were found in the overwhelming number of patients, regardless of BMI. 90% of women noted decrease in fatigue/fatigue on the FACIT scale, and 93% of patients reported satisfaction with treatment, regardless of the Charlson comorbidity index. The need for NSAIDs after one month of use of the Artroflex^® compound decreased by 7%, after 3 months – by 23%. A negative feedback was found between the baseline indicator of health status and the assessment of the effectiveness of therapy. No serious ARs were identified during the study.
Conclusion. Feasibility of using the Artroflex^® compound in real clinical practice in patients with knee OA and excessive body mass has been shown.

A 36-year-old male patient who originally presented with recurrent inflammations in the mastoid, otitis media and peripheral facial paralysis was diagnosed with sterile pachymeningitis, associated with high titres of antineutrophil cytoplasmic antibodies (cANCA) directed against proteinase 3 (PR3). Induction therapy with oral prednisolone 1 mg/kg body weight and cyclophosphamide (CYC) 750 mg/m 2 i.v. every 4 weeks was initiated. Due to side effects, increasing arthralgias and progressive meningitis after 5 doses of CYC, treatment was changed to rituximab (RTX), one cycle comprising two administrations of 1000 mg RTX i.v. two weeks apart, repeated every 6 months. After the very first cycle of RTX, we confirmed subjective improvement of the patient’s fitness as well as radiologic response. Methotrexate (MTX) was added to ease arthralgias. Painful bleeding ulcerations on finger tips were successfully treated with 22 iloprost infusions. Up to date, we have administered 7 cycles of RTX and achieved complete remission of the cANCA-associated vasculitis. After the induction therapy, maintenance treatment with MTX or rituximab will be performed for at least 18–24 months.
We can demonstrate a complete remission with the use of RTX in a patient with cANCA-associated vasculitis and sterile pachymeningitis who failed to respond to the induction treatment with CYC. RTX has been well tolerated.

The article discusses one of the variants of overlap syndrome – a combination of symptoms of ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Three clinical cases are described, in these cases characteristic signs of both diseases were noted and the criteria of both diseases were met. The genetic factors and immunopathogenetic mechanisms underlying AS and RA are analyzed. A review of the literature on the combination of AS and RA is presented.

We present a clinical case of combination of axial spondyloarthritis (axSpA) and chronic recurrent skin lesions in the form of acne conglobata, hidradenitis suppurativa (HS) with fistulous tracts formation. During the diagnostic search, the following diseases were considered: HS, SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), PASS syndrome (pyoderma gangrenosum, acne, ankylosing spondylitis, HS). The choice of therapy in this patient and the possibility of using biologic disease-modifying antirheumatic drugs for axSpa and concomitant autoinflammatory skin process are discussed.

We present two clinical cases: the first patient had combination of antiphospholipid syndrome (APS) and melanoma, and the second – systemic lupus erythematosus (SLE) and APS, melanoma, infiltrative tuberculosis and Herpes zoster. Managing patients with SLE combined with APS is really challenging. Infections and malignant neoplasms, along with kidney damage and cardiovascular diseases, are a significant cause of death in this cohort of patients. The role of antibodies to phospholipids in the onset of malignancy is still under discussion. The combination of rheumatic diseases with oncological or infectious pathology complicates therapy, limiting the use of drugs, recommended by clinical guidelines.

Over the past 50 years the survival rate of patients with systemic lupus erythematosus (SLE) significantly improved, however, it is necessary to develop a new generation of drugs for the treatment of lupus nephritis (LN), the development of which is one of the main factors of high mortality risk in at least 50% of SLE patients. The international clinical trial BLISS-LN has demonstrated a high rate of achievement and maintenance of renal response (RR), confirmed by a higher rate of achievement of RR primary efficacy and complete renal response when using belimumab (BLM) in addition to standard therapy (ST) compared to ST alone in patients with LN. When using BLM, there was a statistically significant reduction in the risk of developing adverse renal events (in particular, deterioration of renal function) or death within 104 weeks compared with placebo. Improvement in LN outcomes was achieved in the setting of long-term reduction in glucocorticoids use after the induction phase. With BLM therapy, there was also a decrease in the total activity of SLE, a decrease in the number of severe exacerbations, and an improvement in serological markers. The benefit/risk ratio of BLM in combination with ST for LN treatment was favorable. BLM can be recommended for LN therapy in combination with standard treatment methods in order to achieve and maintain remission.

The review provides a brief description of the clinical and serological markers of antiphospholipid syndrome (APS), risk factors for the development and recurrence of thrombosis in APS. A complete description of the GAPSS and its simplified (corrected) version, adjusted GAPSS (aGAPSS), as well as the DIAPS, is presented. These scales allow one to determine the activity of APS and reflect the range of cumulative and/or irreversible damage due to the disease.

The article discusses modern approaches to the gout treatment, presented in foreign and domestic clinical guidelines. While the use of urate-lowering therapy for gout is a necessary and highly effective strategy, in the case of asymptomatic hyperuricemia, the benefits of this approach are not clear. The safety and efficacy of colchicine, as well as its cardioprotective properties, were noted in comorbid patients suffering from gout and cardiovascular diseases. Comparative data on safety and efficacy of the main urate-lowering drugs, allopurinol and febuxostat, are presented. It has been shown that, according to recent studies, febuxostat is more effective than allopurinol in normalizing serum uric acid levels, is not inferior in its cardio safety and is characterized by a lower incidence of other adverse reactions.

The treatment of acute pain is a fundamental goal for doctors of various specialties. Tapentadol, which combines the properties of an opioid receptor agonist and a noradrenalin reuptake inhibitor, is one of the most popular analgesics in the world that is effective in severe acute pain. We provide a review of international publications about pharmacological properties, efficacy and safety of tapentadol immediate release (IR) in acute pain. Data from phase II and III of randomized controlled trials (RCTs), in which tapentadol IR (50, 75 and 100 mg) was used for moderate to severe pain in surgical and therapeutic practice is discussed. A number of studies have compared tapentadol with placebo groups and classical opioids (oxycodone, morphine). The results of two meta-analyzes and systematic reviews of efficacy and safety of this analgesic in patients with acute pain are presented.
International multicenter RCTs have demonstrated high efficacy of tapentadol IR 50, 75 and 100 mg in patients in the early postoperative period. Comparison with other opioid analgesics showed that tapentadol was superior to placebo and comparable to oxycodone in analgesic effect.
It was concluded that tapentadol has a better safety and tolerability profile than classical opioids. The incidence of adverse events on this drug is lower than on oxycodone or morphine.

Currently chondroitin sulfate (CS) is the most studied drug from the group of «chondroprotectors». The article shows the role of CS in the treatment of osteoarthritis (OA): mechanism of action, clinical efficacy and safety in patients with OA with comorbidity. Evidence for the effectiveness and safety of the use of CS has been analyzed. The place of this drug in Russian and international clinical guidelines for the management of patients with OA is discussed.
In domestic practice, the parenteral form of CS is often used in patients with OA. The parenteral form of CS for intramuscular and intra-articular administration (Chondroguard^®) has a number of advantages, including the rapid onset of the effect. This enables reducing the dose in a short time or completely abandon the use of non-steroidal anti-inflammatory drugs (NSAIDs), which is extremely important for patients with OA with comorbidity. Chondroguard^® can be recommended for initial use in exacerbations of chronic joint and back pain in OA, including in patients with relative and absolute contraindications for NSAID therapy.

On April 28, 2021, a meeting of the Council of Experts was held with the participation of the leading experts in the field of rheumatic diseases, approaches to the treatment of patients with systemic lupus erythematosus (SLE) were discussed. The issues of medical care for patients with SLE and their routing, key points of Russian and international clinical guidelines for the management of patients with SLE, as well as the role of interferon (IFN) type I in the pathogenesis of the disease were discussed. It is noted that the management of patients with SLE requires a multidisciplinary approach. The basis of therapy is the use of glucocorticoids (GC), immunosuppressive drugs and their combinations. But long-term use of GC in patients with SLE leads to severe complications. Early prescription of biological disease-modifying antirheumatic drugs (bDMARDs) allows to achieve the greatest effect and prevent the development of irreversible organ damage associated with SLE. Currently data from three clinical trials on the efficacy and safety of the type I IFN inhibitor anifrolumab are available. During the discussion, experts defined the clinical profile of a patient with SLE, for whom administration of bDMARD therapy is indicated. According to experts, the use of a type I IFN inhibitor in routine clinical practice can improve disease outcomes in both short and long term.

Introduction of biosimilars of biological disease-modifying antirheumatic drugs (bDMARs) into clinical practice has significantly expanded the availability of bDMARD therapy for a wide range of patients with chronic immuno-inflammatory diseases.
In 2020, the first biosimilar etanercept Erelzi^®, was registered in the Russian Federation. On May 22, 2021, an interdisciplinary Expert panel meeting was held on the use of Erelzi^® for the treatment of rheumatic diseases and psoriasis. The leading Russian rheumatologists and dermatologists participated in this meeting. In the resolution of the Expert panel, it was stated that according data from randomized clinical trials and real clinical practice and due to low immunogenic potential of Erelzi, it can be used in initial therapy and in switching from other bDMARDs therapy in patients, who develop adverse reactions or face loss of their therapy effectiveness.