Granulomatosis with polyangiitis (GPA) is a primary vasculitis associated with antineutrophil cytoplasmic antibodies, characterized by necrotizing vasculitis with predominant involvement of small vessels of various localization and necrotizing granulomatous inflammation with multiple clinical manifestations. GPA remains one of the most severe and prognostically unfavorable systemic vasculitis. The second part of the article presents data on the differential diagnosis of the onset of the disease with the ocular and ear involvement, which requires an interdisciplinary approach and interaction between doctors of different specialties. In the refractory course of the local form of GPA, immunosuppressive therapy, including glucocorticoids and rituximab or cyclophosphamide, is advisable.

The problem of comorbidity is widely discussed in modern medical literature. Its role in rheumatic diseases is of particular interest due to their multifactorial nature and the involvement of a wide range of pathogenetic mechanisms. For many years, researchers around the world have noted correlations between the presence of active autoimmune disorders and the complicated course of cardiovascular diseases. A deeper understanding of the pathogenetic mechanisms at the present stage of development of rheumatology allows us to take a fresh look at the relationship between atherosclerosis and rheumatoid arthritis. The definition of multimorbidity developed in recent years and the results of recent scientific studies may contribute to a more correct choice of tactics for managing patients with a combination of these two diseases.

Objectives To assess the efficacy and safety of olokizumab (OKZ), a monoclonal antibody against the interleukin-6 (IL-6) cytokine, versus placebo (PBO) in patients with prior inadequate response to tumour necrosis factor inhibitors (TNFi-IRs).

Methods In this 24-week multicentre, placebo-controlled, double-blind study, the patients were randomised in a 2:2:1 ratio to receive subcutaneously administered OKZ 64 mg once every 2 weeks (q2w), OKZ 64 mg once every 4 weeks (q4w) or PBO plus methotrexate. At week 16, the patients on PBO were randomised to receive either OKZ regime. The primary endpoint was the proportion of patients achieving an American College of Rheumatology 20% (ACR20) response at week 12. Disease Activity Score 28-joint count C-reactive protein (DAS28 (CRP)) <3.2 at week 12 was the major secondary efficacy endpoint. Safety and immunogenicity were assessed.

Results In 368 patients randomised, ACR20 response rates were 60.9% in OKZ q2w, 59.6% in OKZ q4w and 40.6% in PBO (p<0.01 for both comparisons). Achievement of DAS28 (CRP) <3.2 was significantly different, favouring the OKZ arms. Improvements in efficacy and patientreported outcomes were maintained throughout 24 weeks and were noted after week 16 in patients who switched from PBO.Dose-related treatment-emergent serious adverse events were 7% in OKZ q2w, 3.2% in OKZ q4w and none in the PBO group.

Conclusions Direct inhibition of IL-6 with OKZ resulted in significant improvements in the signs and symptoms of rheumatoid arthritis compared with PBO in TNFi-IR patients with a similar safety profile as observed for monoclonal antibodies to the IL-6 receptor.

Psoriasis is associated with an increased risk of cardiometabolic pathology. Comparative studies of this pathology’s prevalence in patients with psoriasis depending on the presence of psoriatic arthritis (PsA) in a representative sample of Russian patients have not been conducted.

Objective:to compare the prevalence of cardiometabolic diseases in Russian patients with psoriasis depending on the presence or absence of PsA.

Material and methods. The data of the register of patients with psoriasis of the Russian Society of dermatovenerologists and Cosmetologists (RODVK) were analyzed. Inclusion criteria: age >18 years, information about the established diagnosis of PsA. A comparison was made between patients with PsA and two comparison groups: all patients without PsA and patients without PsA with a duration of psoriasis exceeding the established value.

Results and discussion. The analysis included 920 patients with PsA (group 1) and 2325 patients with psoriasis without PsA (group 2). Group 3 included 655 patients from group 2.

The prevalence of cardiometabolic diseases in patients with PsA was higher than in group 2. When compared to group 3, the statistically significant differences were noted only for impaired glucose tolerance. However, adjusted for gender and age, patients with PsA had statistically significant higher chances of developing arterial hypertension (AH), coronary heart disease, angina pectoris, acute cerebrovascular accident, impaired glucose tolerance and diabetes mellitus than patients in group 3. When adjusting for disease risk factors, the statistical significance of differences remained for hypertension and angina pectoris.

Conclusion. The prevalence of cardiometabolic diseases in Russian patients with PsA is higher than in patients with psoriasis without PsA.

Objective: to identify risk factors for the development of the femoral head aseptic necrosis (FHAN) and osteoarthritis (OA) of the hip joint (HJ) in patients with systemic lupus erythematosus (SLE) according to a retrospective analysis.

Material and methods.The retrospective study included data from the case histories of 103 patients with SLE who underwent total hip arthroplasty (HA) (unilateral in 82 patients, bilateral in 21). The total follow-up period ranged from 2 years to 21 years. Among the patients included in the

study, the majority were women (86.4%), the ratio of women and men was 7:1. At the time of surgery, the average age of women was 36.3±13.25 years, men – 36.2±9.57 years, duration of the disease – 168.0±132.5 months. SLE activity was assessed using the SLEDAI-2K scale. All patients were taking glucocorticoids (GC). The average duration of GC treatment was 89.0±87.2 months. 71.8% of patients received immunosuppressive therapy: hydroxychloroquine – 55.3%, azathioprine – 10.7%, methotrexate – 5.8%. The functional status of hip joint was determined using the Harris scale; by the time of surgery, the average score was 45.6±13.1 points. Pain intensity was assessed using a visual analogue scale and reached an average of 70.1±16.0 mm.

Results and discussion. In 58.5% of patients with SLE, the indication for HA was FHAN (Group 1) and in 41.6% – OA of HJ (Group 2). At the time of HA, the duration of the disease was longer and the age was higher in group 2 than in group 1 (p<0.05). An analysis of individual clinical manifestations of SLE that preceded the development of HJ pathology revealed that arthritis and the presence of an antinuclear factor, ANF, were associated with the development of FHAN (p=0.022 and p=0.04, respectively). At the onset of the disease, patients of the 1st group, compared with patients of the 2nd group, more often had lesions of the skin, kidneys and serositis (22.9 and 20.5%; 14.5 and 11.7%; 68.7 and 64.7 %, respectively), but they were less likely to have mucous membranes and the central nervous system (CNS) involvement (14.5 and 23.5%; 10.4 and 17.6%, respectively). However, these differences did not reach statistical significance. Almost all of these disease manifestations, with the exception of the mucous membranes and the CNS lesions, were more often observed in patients with the development of FHAN, which indicates a higher activity of the disease at the onset of SLE. At the time of HA, we did not find any relationship between SLE activity and FHAN formation and hip OA. Patients of the 1st and 2nd groups in the same number of cases had mild (56.2 and 58.8%, respectively) and moderate (35.4 and 32.4%, respectively) activity according to SLEDAI-2K. No activity (SLEDAI-2K – 0 points) was also observed in patients of both groups with the same frequency (8.3 and 8.8% of cases, respectively). Associations of cumulative and daily doses of GC with the development of FHAN and OA of HJ were not revealed. In the 1st group, the average daily dose of GC was slightly higher, and the cumulative dose was less than in the 2nd group (8.59±4.75 and 7.79±5.39 mg; 20.0±11.9 and 23.8±19.2 g, respectively), but these differences were not significant (p>0.05).

Conclusion. In SLE patients, the incidence of FHAN and HJ OA was comparable. At the time of HA, SLE patients with HJ OA were older and had a longer duration of the disease than patients with FHAN. The risk factors for FHAN were arthritis and ANF positivity at the onset of SLE.

Osteoarthritis (OA) is the most common joint disease that affects more than 80% of people over 55 years and in its final stages leads to disability. One of the safe non-surgical methods of OA treatment is intra-articular injections of hyaluronic acid (HA).

Objective: to compare the viscoelastic rheological properties of HA medical products with different concentrations of sodium hyaluronate (SH) available in the Russian Federation.

Material and methods. The study was carried out using a modular rheometer MCR 302 (Anton Paar, Austria). All measurements were carried out at a temperature of 25.0±0.1 °C using the measuring system "cone-plane" (angle – 2 ˚ , cone diameter – 40 mm, gap height – 0.169 mm). The determination of the elastic moduli (G’) and viscosity (G”) was carried out depending on the frequency in the linear region of the shear stress, and the dynamic viscosity was determined at a shear rate of 1 sec-1.

Results. The evaluation of the rheological properties of the studied samples revealed a positive relationship with the concentration of SH and no relationship with the molecular weight of SH. The highest viscoelastic properties were possessed by medical products in the 1% SH group: Armaviscon and Ripart; in the group with SH concentration of 1.5–1.6%, all the studied samples, except for Hyalubrix, showed similar higher results compared to the previous group; in the group with SH concentration of 2–3%, Armaviscon Platinum had the highest results and Flexotron Ultra and Armaviscon Forte – somewhat lower results.

Conclusion. The study of the rheological viscoelastic properties of HA medical products is the most accessible method, on the basis of which it is possible to predict the clinical effect.

Evaluation of the effect of new drugs should be carried out in randomized controlled trials (RCTs), and observational studies (OSs) are carried out to confirm and refine the results obtained in RCTs, for example, to study the effectiveness of drugs in large groups of patients who were not included in RCTs or had comorbidities or older age.

Objective: to evaluate the effectiveness of Alflutop (AF) via OS of patients with osteoarthritis (OA) of the knee and/or hip joints and/or low back pain (LBP) with or without comorbid diseases.

Material and methods. A multicenter prospective cohort OS was conducted in 163 clinical centers in 58 cities of the Russian Federation and included 22,525 patients with OA and LBP who received AF as a part of a planned treatment prescribed by a doctor, or self-prescribed and purchased in a pharmacy. Pain, satisfaction with therapy, health assessment, need for non-steroidal anti-inflammatory drugs (NSAIDs), and quality of life were recorded using the EQ-5D questionnaire.

Results and discussion. After one treatment course with AF, improvement was detected in 98% of cases, there was a rapid positive trend with a significant decrease in pain, the median time to clinical effect was 8 [5; 10] days. Assessment of general health status and satisfaction with therapy improved significantly. In 94.5% of patients, the daily requirement for NSAIDs decreased.

Conclusion. The first results from the OS confirm the symptomatic effect of AF.

Rhupus is a rare combination of systemic lupus erythematosus (SLE) and rheumatoid arthritis, one of the characteristic features of which is the development of erosive polyarthritis on the background of the main immunological signs of SLE. The article presents a clinical observation in which, along with the typical immunological picture of SLE, the patient was diagnosed with erosive polyarthritis with “swan neck” type deformities of the hand joints, which required administration of anti-B-cell therapy.

The article presents the results of treatment of patients with systemic lupus erythematosus (SLE), who, due to resistance to traditional regimens, for the first time in the Russian Federation were included in the early access program of the type I interferon inhibitor – anifrolumab. Clinical data and results of instrumental examinations of a patient with SLE on the background of 6-month therapy are presented.

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease of unknown etiology, characterized not only by joint destruction, but also by visceral organ involvement. Interstitial lung disease is considered the most common and serious pulmonary complication of RA, with a prevalence of about 50% according to most studies. As a rule, involvement of the lungs occurs several years after the onset of RA. The article presents a description of a clinical case of the development of respiratory disorders (severe dyspnea) as early as a month after RA onset.

Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) is a concern for both doctors and patients. However, in axial spondyloarthritis (axSpA), NSAIDs are used not only as a symptomatic therapy, but also to prevent the progression of the disease. Therefore, in active axSpA, NSAIDs are recommended to be administered for a much longer period of time than it is indicated in the instructions for use of the drug. The article presents two clinical cases of long-term use of etoricoxib in active axSpA. In both cases, clinical efficacy and resolution of active osteitis in the sacroiliac joints, good tolerability of treatment were noted.

A characteristic feature of rheumatic diseases (RD) is a chronic inflammatory process, which contribute to their pathogenesis, and determines the formation of a persistent pain syndrome. Therefore, in current recommendations for the treatment of RD, the main attention is paid to the correction of disorders that induce pain caused by inflammation. Meanwhile, more and more data are accumulating on the participation of noninflammatory mechanisms in the development of pain in RD. In some cases, the clinical picture of RD is determined by the simultaneous participation of several mechanisms. At the same time, the symptoms associated with the inflammatory process can eventually transform into a different pain phenotype, which persists even after the suppression of inflammatory changes. In such a situation, a correct assessment of the patient's status can cause serious difficulties. The results of the studies show that in everyday clinical practice, when assessing the status of a patient, in addition to the disorders characteristic of each disease, it is necessary to take into account the possibility of the presence of symptoms due to the mechanisms of central sensitization common to various joint diseases.

The article presents a review of current data on arteriovenous thrombosis risk factors in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Thrombotic complications are among the most frequent prognostically unfavorable factors in AAV. In general, patients with AAV are at greater risk of mortality from cardiovascular events compared with the general population and patients with other forms of systemic vasculitis. Understanding the mechanisms of thrombosis, as well as pathogenic factors that cause an increased risk of arterial and venous thrombosis in AAV, can improve the quality of management of these patients. Therefore, the question of the need for primary and secondary prevention of thrombosis in AAV is of great practical importance. The presented data show the need to estimate the probability of thrombosis in patients with AAV, taking into account risk factors, as well as the influence of the disease itself and ongoing therapy. Assessment of the risk of thrombosis (both venous and arterial) is necessary for the timely administration of adequate preventive treatment of thrombotic complications in AAV.

Skin and mucous membrane lesions are frequently seen in systemic lupus erythematosus (SLE) with the juvenile onset (juSLE), and they are extremely diverse. Skin manifestations can be the initial sign of the disease, they often respond first to adequate therapy, and recurrence or the appearance of a new type of lesions is the earliest indicator of exacerbation in many patients. In severe cases, skin lesions can lead to irreversible cosmetic defects, significantly affecting the quality of life. The article presents the clinical manifestations of various variants of skin and mucous membrane lesions in SLE with a debut in childhood and adolescence, their recognition is important for the timely diagnosis of SLE, as well as the correction of therapy for an existing disease, which improves the long-term prognosis and quality of life of patients.

Chronic hyperuricemia (CH) and gout are independent risk factors for decreased kidney function. In the last decade, evidence was accumulating that urate-lowering therapy may be an effective method of slowing down the progression of CH and gout-mediated renal failure. At the same time, the main goal of gout therapy is the complete resorption of urate crystals, which leads to resolution of the disease, but is impossible without longterm use of urate-lowering drugs. However, the treatment of gout in the presence of chronic kidney disease is much more complex and requires consideration of the potential impact of drugs on targeted serum uric acid level and on renal function, as well as predicting the risk of adverse events. The article presents practical recommendations regarding the use of urate-lowering drugs in gout patients with chronic kidney disease.

The historical essay presents the main stages in the development of scientific views on rheumatoid arthritis, starting from the middle of the 19th century and until the middle of the 20th century, history of research of its characteristic clinical and instrumental signs, diagnostic criteria, methods of drug therapy.

On April 1, 2023, experts presented a resolution of the First Multidisciplinary Bilateral Russia–Uzbekistan Expert Council, dedicated to innovations in the prediction and personalized prevention of degenerative-dystrophic diseases of the joints and spine, and the possibilities of using the new pharmaconutraceutical Chondroguard®TRIO, the components of which (chondroitin sulfate, glucosamine sulfate, undenatured collagen type II – NK-II type) can be attributed to active compounds that modify the course of the disease (Disease-modifying osteoarthritis drugs, DMOADs) through structure-modifying and immune-mediated mechanisms of action. The evidence base for the efficacy and safety of the use of the main components of the new pharmaconutraceutical Chondroguard®TRIO (chondroitin sulfate, glucosamine sulfate, type NK-II) for the prevention and adjunctive therapy of osteoarthritis and nonspecific back pain is presented in the clinical recommendations of foreign specialized associations: Osteoarthritis Research Society International (OARSI), European Alliance of Associations for Rheumatology (EULAR), European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), American College of Rheumatology (ACR), Russian Clinical Guidelines of the Russian Ministry of Health, as well as in numerous interventional and observational clinical studies.