Rheumatology Science and Practice

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Since 1958 the “Nauchno-prakticheskaya revmatologiya" (Rheumatology Science and Practice)  journal publishes timely articles, balancing both clinical and experimental research, case reports, reviews and lectures on pressing problems of rheumatology. The Journal is aimed to provide a forum to discuss etiology and pathogenesis, clinical features, modern diagnostic and treatment approaches to rheumatology and its complications, as well as associated conditions.










Current issue

Vol 57, No 3 (2019)
View or download the full issue PDF (Russian)


250-254 31

Psoriatic arthritis (PsA) is a chronic immunoinflammatory disease that, on the one hand, is considered as the most common comorbidity in psoriasis as part of systemic psoriatic disease, and, on the other, is classified as a clinical form of spondyloarthritis and lies at the interface of the basic problems of rheumatology and dermatology. The study of the evolution of psoriasis in relation to the development of PsA is a research priority area in rheumatology and dermatology, which is important for deciphering the nature of heterogeneity and the immunopathogenesis mechanisms of these diseases and for developing novel methods of personalized therapy at different stages of diseases.


255-264 46

The paper details 15 new recommendations of the Canadian Rheumatology Association for the clinical monitoring of patients with systemic lupus erythematosus (SLE). During their development, the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) classification system for rating the quality of recommendations was used for the first time. The recommendations for physician specialization; cardiovascular risk assessment; anti-Ro/SSA and anti-La/SSB antibody concentrations examination during pregnancy; and annual influenza vaccination are considered to be strong; those for rating disease activity and damage index; ultrasound of the carotid arteries; diagnosis of osteoporosis and osteonecrosis; Doppler ultrasound of uterine and fetoplacental blood flow during pregnancy; screening for cervical cancer, viral hepatitis B and C in patients with SLE are regarded as conditional.


265-273 16

The choice of drugs for the treatment of interstitial lung disease (ILD) associated with systemic sclerosis (SS) is currently very limited. Data from a number of studies show that rituximab (RTM) can improve lung function and reduce the severity of skin fibrosis in patients with SS.

Objective: to evaluate the efficiency of RTM in a cohort of patients with SS-associated ILD after one-year follow-up. The indications for prescribing RTM were: 1) the inefficiency of standard therapy with glucocorticoids and immunosuppressants (ISs) or the impossibility of their use; 2) the early stage (first 3 years of the disease) with signs of poor prognosis, such as diffuse form, high skin scores (>14), male gender, rapid progression with a significant initial decline in forced vital capacity (FVC) and/or diffusion lung capacity (DLC), and a high anti-Scl-70 antibody positivity.

Subjects and methods. The investigators selected a group of patients who had at least two assessment points at a 12-to-18 month interval (the mean follow-up period of 13±2 months) and took at least 1 g of RTM during this period. The investigation included 71 patients with a valid diagnosis of SS. Multi-slice spiral computed tomography (MSCT) revealed ILD in 90% of patients. The disease duration was 5.6±4.4 years. The presence of anti-Scl-70 antibodies was detected in 73% of patients. The mean cumulative dose of RTM was 1.43±0.6 g; 48 patients in Group 1 received ≤2 g of RTM (the mean dose, 1.1±0.1 g) and 23 patients in Group 2 took ≥2 g of RTM (mean dose, 2±0.6 g). Before starting treatment with RTM, all the patients received concomitant therapy with prednisone and 45% - with immunosuppressants.

Results and discussion. The results assessed by a physician showed that good and moderate effects of the therapy were observed in 52 (73.2%) and 16 (22.6%) patients, respectively; no effect was seen in 3 (4.2%) patients. Overall, 95.8% of patients reported various degrees of improvement. There were significant changes as reductions in the disease activity index, skin scores, C-reactive protein and IgG levels, the number of patients with a high antinuclear antibody level, and the mean dose of prednisolone as well as increases in an oral aperture size, left ventricular ejection fraction, and 6-minute walk test scores. There were no changes in pulmonary artery systolic pressure and the HAQ DI. FVC increased from 77.35±19.9 to 82.6±20.7% (p=0.001). A minimal clinically significant increase in FVC ≥5% was noted in 41 (57.7%) people. The overall improvement in FVC (ΔFVC) reached 5.24%, while the changes were more significant in Group 2 (ΔFVC 8.98%) than in Group 1 (ΔFVC 3.75%; p=0.01). DLC remained stable, but there were significant group differences: ΔDLC was 3.75% in Group 2 and, conversely, decreased in Group 1 (1.6%; p=0005). The safety profile of the therapy was regarded as good and quite comparable with both the safety profile of ISs and the use of RTM in other trials. Infectious complications were recorded to be most common in 11 (15%) people. Of these, upper respiratory tract infections developed in 7 patients; plantar phlegmon occurred in one case; urinary tract infection and herpes zoster were detected in two and one cases, respectively.

The results of this study confirm data from other studies that have demonstrated that RTM exerts a positive effect on SS-associated ILD. We were the first to show the association of positive changes in the measures of pulmonary function tests with the dose of RTM.

274-279 14

Objective: to analyze therapy with rituximab (RTM) in real clinical practice according to the data available in OREL registry of patients with active rheumatoid arthritis (RA).

Subjects and methods. The analysis included 349 patients. All the patients received RTM: 340 – the original drug (MabThera®) and 9 – the biosimilar Acellbia®. 263 patients (75.4%) received RTM in combination with disease-modifying anti-rheumatic drugs (DMARDs) and 86 (24.6%) – RTM as monotherapy.

Results and discussion. Of the 349 patients included in the analysis, 272 (77.9%) patients received RTM as the first biologic agent (BA) (263 patients were treated with the original drug and 9 – with the biosimilar) and 77 (22.1%) patients had previously used the BA. The majority of patients (n=205 (58.7%)) received three or more; 109 (31.2%) patients – one, and 35 (10%) – two RTM courses of RTM therapy. RTM caused a significant reduction in disease activity just after the first therapy course and in the levels of acute-phase reactants (C-reactive protein (CRP) and ESR); after the fifth therapy course, median CRP concentration decreased by 1.4 times and amounted to 7 [1.2; 17.9] mg/l and that of ESR reduced by 1.8 times and was 10 [5; 20] mm/hr (p<0.05).

Conclusion. The analysis of RTM therapy in RA patients in real clinical practice demonstrated that in most cases RTM was given as the first BA, in combination with DMARDs, the main agent of which was methotrexate. The use of RTM was accompanied by a significant reduction in disease activity and in the serum levels of acute-phase reactants and autoantibodies.

280-283 11

Objective: to determine the incidence of insulin resistance (IR) in patients with rheumatoid arthritis (RA) and to assess the relationship of IR to blood lipid profile changes and the presence of metabolic syndrome (MS).

Subjects and methods. The investigation enrolled 47 RA patients (41 women and 6 men) without a history of diabetes mellitus (DM) and with normal fasting glucose levels during examination. The patients' median age was 56 [39; 62] years; disease duration – 6 [5; 14] years. Most of the patients had low (40.4%) or moderate (42.6%) RA activity (DAS28). IR was diagnosed using the Homeostastic Model Assessment of Insulin Resistance (HOMA-IR) index 2.77. The presence of MS was assessed by the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATPIII) criteria and the International Diabetes Federation (IDF) criteria.

Results and discussion. The median HOMA-IR value in RA patients was 1.7 [1.1; 3.2]. The HOMA-IR index correlated with age (r=0.3; p=0.04), body mass index (r=0.6; p<0.001), waist circumference (r=0.6; p<0.001), and the concentrations of total cholesterol (r=0.3; p=0.02) and triglycerides (TG) (r=0.5; p<0.001). All the patients were divided into two groups: 1) 15 patients with IR; 2) 32 patients without IR. The patients of both groups were matched for sex, age, RA duration and activity, and therapy, but the RA patients with IR more often had abdominal obesity (100.0 and 37.5%), hypertriglyceridemia (33.3 and 6.3%) and the atherogenic index >3.0 (40.0 and 6.3%, respectively; p<0.05 in all cases). MS was diagnosed using the NCEP/ATPIII criteria in 46.7% of cases with RI and in 6.3% of those without IR; MS was identified by the IDF criteria in 60.0 and 12.5% of cases, respectively (p<0.01 in all cases). There were no differences between groups in the incidence of hypertension, myocardial infarction, or in the frequency of surgeries for myocardial revascularization.

Conclusion. More than 30% of RA patients without DM have IR (HOMA-IR ≥2.77). IR in RA is associated with obesity, elevated blood TG levels, and a proatherogenic lipid profile. The use of the criteria for MS could not always allows suspect IR in patients with RA.

284-288 12

Rheumatoid arthritis (RA) and glucocorticoid use are the most common causes of secondary osteoporosis (OP). Early detection of individuals at high risk for osteoporotic fractures among RA patients allows timely prevention of OP and its complications.

Objective: to evaluate the diagnostic possibilities of using a FRAX® calculator without introducing femoral neck bone mineral density (BMD) into the algorithm, as well as different therapeutic intervention thresholds to identify RA patients who need anti-osteoporotic therapy.

Subjects and methods. The investigation enrolled 97 RA patients aged over 50 years. A questionnaire survey and axial skeletal densitometry were made; the 10-year fracture risk was calculated using the FRAX® calculator with and without femoral neck BMD. The diagnostic characteristics (sensitivity, specificity, ROC-curves) of different therapeutic intervention thresholds (Russian and European age-dependent intervention thresholds; 20% and 10%) for FRAX) were studied.

Results and discussion. The capabilities of the Russian FRAX® model with and without femoral neck BMD to identify patients requiring treatment for OP were very good (AUC=0.878±0.036 and AUC=0.872±0.040, respectively). Lumbar spine dual-energy X-ray absorptiometry also identified very well RA patients who should undergo prophylaxis against OP and related fractures (AUC=0.837±0.063), while femoral neck and whole hip BMD values showed lower accuracy in detecting these patients (AUC=0.587±0.102 and AUC=0.625±0.092, respectively). The Russian age-dependent threshold showed 79.7% sensitivity and 63.7% specificity in evaluating the FRAX® algorithm without BMD; these figures for FRAX® with BMD were 82.2 and 65.2%, respectively. The use of FRAX® without and with BMD revealed no significant differences in the identification of persons in need of treatment (χ2=0.22; p=0.64). The sensitivity and specificity of other therapeutic intervention thresholds in determining the fracture risk with and without BMD were as follows: 90.4-94.6 and 17.4-21.7% for the European threshold; 58.8 and 93.8% for 20%, and 96.5% and 0 for 10%, respectively.

Conclusion. The FRAX® calculator can be used to assess a fracture risk without entering the femoral neck BMD data into the algorithm for RA patients aged 50 years and older. Fracture risk should be assessed using the Russian agedependent threshold that adequately identifies those who need OP treatment among RA patients.

289-293 13

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are the most common autoimmune rheumatic diseases (RD) that occur mostly in women of childbearing age, and the occurrence of pregnancy is an expected fact. Due to the ongoing disputes over the ethics of maintaining birth rates among an unhealthy population, modern researchers focus attention on studies of the mutual impact of RD and pregnancy, on the safety of pharmacotherapy during conception and gestation, and on the health of the offspring born to female patients with RD.

Objective: to evaluate the neonatal outcomes of pregnancy in patients with RA and SLE.

Subjects and methods. An investigation was conducted to study the health status of 73 babies born to 72 female patients with RD (76 cases of pregnancy), of whom 29 patients with RA (32 cases of pregnancy) and 43 with SLE (44 cases of pregnancy) were followed up prospectively at the V.A. Nasonova Research Institute of Rheumatology and the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology. The health status of the babies was evaluated in the first year of their life. Supervising neonatologists and pediatricians recorded abnormalities in the newborns and subsequently analyzed using their medical records (extracts from maternity hospitals, children's hospitals, and outpatient cards).

Results and discussion. Of the 76 supervised pregnancies, 72 (94.7%) resulted in 73 live births (one twin pregnancy in a patient with SLE). There were three (6.8%) cases of pregnancy loss in the second trimester in patients with SLE having antiphospholipid syndrome (APS) and one (3.1%) case of perinatal death (a boy and a girl from a monochorionic diamniotic twin with reversed arterial perfusion) in a patient with seropositive RA. The height and body weight of all the newborns conformed to gestational age. Patients with RA and SLE compared to the population more often gave birth to low birthweight babies (9.7 and 21.4% versus 60.9 per 1,000 live births in the Russian population). In the groups of mothers with RA and SLE, their infants had a high Apgar score of 8–9 at one and five minutes. Various abnormalities were detected in 5 (16.1%) and 15 (35.7%) babies born to mothers with RA and to those with SLE, respectively. Among the neonatal congenital anomalies (malformations), there was patent foramen ovale, patent ductus arteriosus, and hip joint dysplasia, which were more common in the babies born to mothers with SLE having APS and exceeded the population-based incidence of these anomalies. The babies were more commonly diagnosed with congenital pneumonia than those in the population; there were single cases of umbilical hernia, hemangioma, thrombocytopenia, hemorrhagic disease of the newborn, perinatal encephalopathy, and congenital hearing loss.

Conclusion. The mothers with RA and SLE more often gave birth to low birthweight babies than did those in the population. The infants born to mothers with RA and SLE had significantly more frequently congenital heart defects (patent foramen ovale, patent ductus arteriosus) and congenital pneumonia. The detected abnormalities were more common in the newborns born to mothers with SLE having APS. Maternal RA and SLE activities and/or performed therapy were not found to have a negative impact on the incidence of abnormalities in babies.

294-298 10

The Assessment of Spondyloarthritis International Society (ASAS) Health Index (HI) is a comprehensive tool for quantifying the health of patients with axial (ax) spondyloarthritis (SpA), including ankylosing spondylitis (AS). ASAS HI was developed on the basis of the International Classification of Functioning, Disability, and Health (ICF). The questionnaire contains 17 questions, each of which is associated with a specific ICF pool (pain, emotions, sleep, sexual function, ambulation, self-care, and communication).

Objective: to study the psychometric properties of the Russian-language version of ASAS HI.

Subjects and methods. Examinations were made in 245 patients older than 18 years with axSpA or peripheral SpA, who met the ASAS criteria. The main psychometric properties of a questionnaire, such as validity, reliability (reproducibility), and sensitivity, were evaluated. SpA activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS); the functional status of the patients was estimated by the Bath Ankylosing Spondylitis Functional Index (BASFI), and their spinal mobility was evaluated by the Bath Ankylosing Spondylitis Metrology Index (BASMI). The short-form 36 (SF-36) health questionnaire and the 5-dimensional EQ-5D version (EuroQoL) were used to assess quality of life in SpA patients. Patient satisfaction with their health status was estimated using the patient acceptable symptom state (PASS) index.

Results and discussion. The median age of the patients enrolled in the investigation was 39.5 [28.00; 48.00] years; disease duration – 102.5 [23.0; 196.5] months; there were 64.58% of men were and 78% of HLA-B27 positive patients. The median scores were for: BASDAI, 5.40 [3.20; 6.80]; ASDAS, 3.19 [2.55; 4.15]; BASFI, 5.60 [2.60; 7.50]; BASMI, 4.20 [3.00; 6.60]; ASAS HI, 9.00 [7.00; 12.00]; ASAS EF Items Set, 4.00 [3.00; 7.00]. There were statistically significant relationships between ASAS HI scores and C-reactive protein levels (Spearman correlation coefficient r=0.56), BASDAI (r=0.62), BASFI (r=0.67), ASDAS (r=0.38), BASMI (r=0.46), and patient's global assessment on a visual analogue scale (VAS) (r=0.49; p<0.05 for all measures). The ASAS EF Items Set scores correlated with the main clinical characteristics of the patients. There were statistically significant relationships between the ASAS HI/EF Items Set scores and the latter of eight SF-36 scales and the EQ-5D ques tionnaire. Statistically significant differences in ASAS HI scores were found in patients with positive and negative PASS indices (the median value of ASAS HI was 6.89 [3.00; 10.00] and 9.20 [7.00; 12.00], respectively; p=0.000086). Cronbach's internal consistency for ASAS HI was 0.988. There were statistically significant differences in ASAS HI scores before and after treatment (9 [7; 12] and 6 [3; 10], respectively; p=0.00025).

Conclusion. This study confirmed validity, reproducibility, and sensitivity to changes of the Russian-language version of ASAS HI for patients in the Russian Federation.

299-306 8

Objective: to evaluate the clinical efficacy and safety of the targeted synthetic disease-modifying antirheumatic drug (DMARD) apremilast (AP; Otesla®) in patients with active psoriatic arthritis (PsA) at 14 and 26 weeks after starting the treatment and to identify the place of AP in the combination therapy of patients with PsA, by taking into consideration a comorbidity.

Subjects and methods. Examinations were made in 20 patients (11 women and 9 men) with active PsA who had comorbidity, lack of efficiency of or intolerance to previous therapy with synthetic DMARDs or biologic agents, and contraindications to its use. The median baseline Disease Activity in Psoriatic Arthritis (DAPSA) score was 35.6 [24.8; 55.6]; those of DAS and DAS28 were 3.8 [3.2; 5.0] and 4.4 [4.0; 5.2], respectively. AP (Otesla®) was administered in tablets with a starting dose of 10 mg/day with a daily dose escalation of 10 mg to the therapeutic dose of 60 mg/day for 26 weeks. At baseline, 14 and 26 weeks, the disease activity and efficiency of AP were evaluated using DAPSA, DAS, and DAS28, as well as minimal disease activity (MDA) criteria (tender joint count ≤1; swollen joint count ≤1; PASI ≤1 or BSA ≤3%; a patient’s assessment of pain ≤15 mm; patient’s global assessment ≤ 20 mm; Health Assessment Questionnaire (HAQ) ≤ 0.5; enthesitis ≤1). The investigators estimated the number of patients who had achieved remission (DAPSA≤4; DAS<1.6; DAS28<2.6), low activity (5≤DAPSA≤14; 1.6≤DAS<2.4; 2.6≤DAS28<3.2) or MDA (5 of the 7 criteria) during AP therapy at 26-week follow-up. The safety of therapy was evaluated, by analyzing the adverse events (AE): the frequency, severity, and time of their occurrence were studied.

Results and discussion. At 26 weeks after AP therapy initiation, there was a significant decrease of all PsA activity scores as compared to the baseline ones to the following median values: DAPSA 25.9 [11.3; 35.2]; DAS 3.3 [1.8; 3.9], and DAS28 3.4 [2.3; 4.8]. The median BASDAI and ASDAS scores also significantly declined from 5.1 [2.5; 7.3] and 3.35 [2.3; 4.2] to 3.45 [2.15; 6.15] and 2.7 [1.8; 3.35], respectively. The median area of psoriatic skin lesions (body surface area (BSA)) significantly reduced from 2 [0.35; 6] to 1 [0.2; 2]. At 26 weeks after starting AP therapy, the low activity/remission according to DAPSA, DAS, and DAS28 was achieved by 20/10%, 20/15%, and 10/35% of patients, respectively. Three (15%) patients achieved MDA. Fifteen (75%) of the 20 patients completed an AP therapy course. In the period of 14 to 26 weeks, four patients dropped out of the study due to ineffective therapy and one because of a severe AE (pneumonia at 14 weeks of treatment); at 26 weeks, another patient was withdrawn due to lack of effect. At 14 weeks, ten patients had a moderate AE that did not required treatment discontinuation. The most common AE were diarrhea in 5 (25%) patients, headache in 4 (20%), nausea in 3 (15%), and insomnia in 3 (15%).

Conclusion. AP is a safe and effective drug for the treatment of PsA patients with moderate and high inflammatory activity and various comorbidities that do not allow the use of conventional DMARDs.

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Objective: to evaluate the effect of golimumab (GLM) on the clinical, functional, and instrumental manifestations of coxitis in ankylosing spondylitis (AS).

Subjects and methods. The non-interventional prospective multicenter cohort study GO-COX conducted in the medical centers of the Russian Federation enrolled 39 patients with AS (meeting the modified New York criteria) and coxitis with BASRI-hip score 0–2, who were prescribed GLM as the first biologic agent at a dose of 50 mg per month. The patient's health status was assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP), and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) before and at 6 and 12 months after GLM treatment initiation. Based on the data of radiographs (the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-hip) scoring system), ultrasonography (USG), and STIR and T1 magnetic resonance imaging (MRI), the investigators assessed the manifestations of coxitis. The planned follow-up duration was 2 years. This paper includes 12-month follow-up results in 22 patients.

Results and discussion. At 12 weeks of GLM therapy, there were significant positive index changes: a decrease in BASDAI by an average of 3.28±1.62, in ASDAS-CRP by 2.20±0.95, in BASFI by 2.52±2.09, and in BASMI by 1.41±1.50 (p<0.0001). One year after GLM therapy initiation, the BASRI-hip values remained unchanged; 40 to 60% of patients had no MRI and USG signs of coxitis.

Conclusion. At 12 weeks, GLM therapy in patients with AS and coxitis provided a reduction in the clinical and instrumental signs of coxitis, as evidenced by MRI and USG (a significant decline in the proportion of patients with subchondral bone edema and intraarticular effusion), and also effectively suppressed other manifestations of inflammatory activity.

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Objective: to evaluate the effect of golimumab (GLM) on endothelial vasomotor function and arterial stiffness in patients with ankylosing spondylitis (AS).

Subjects and methods. A total of 42 patients with advanced-stage AS, who were older than 18 years and met the 1984 modified New York criteria with a disease duration of ≤5 years, were examined. The investigators visualized carotid arteries to determine local vascular wall stiffness, studied regional arterial stiffness to assess a pulse wave contour analysis, and a reactive hyperemia test before and after 104-week therapy.

Results and discussion. RA patients without cardiovascular comorbidity were found to have signs of subclinical great artery involvement accompanied by endothelial vasoregulatory dysfunction in both the small resistance and large muscular arteries; by increases in common carotid artery (CCA) intima-media thickness (IMT) and stiffness index (SI); by rises in peripheral augmentation index (AIp), SI and reflection index (RI), the intensity of a change in which correlated with disease duration and activity assessed by ASDAS; as well as with the modified Schober test value, cervical rotation, and tragus-to-wall distance. In addition to a decrease in the Ankylosing Spondylitis Disease Activity Score (ASDAS), GML treatment in patients with AS caused a statistically significant increase in the amplitude occlusion index to the control values and a rise in the phase shift between the channels by an average of 2 times (p<0.01) as compared to the baseline values; a decrease in CCA IMT by an average by 20% (p=0.01) and in the local stiffness of the (carotid) vascular bed by 31% (p=0.01). The pulse wave contour analysis after 104-week GLM therapy revealed that AIp, SI and RI decreased by an average of 5 (р<0.001), 1.3 (р<0.01), and 2 (p<0.05) times, respectively, with the remaining statistically significant differences from the control values.

Conclusion. In addition to the effectively reduced inflammatory activity, GLM therapy in patients with AS provides restoration of endothelial function in both the small resistance vessels (an increase in the amplitude occlusion index) and the large muscular arteries (a rise in the phase shift between the channels) and also has a vasoprotective effect on the wall of large elastic vessels (reductions in CCA IMT, SI, AIp, and SI) and small muscular arteries (a decrease in RI).


318-327 17

The review summarizes current idea on the key role of interleukin 6 (IL-6) in the pathogenesis of rheumatic diseases (RDs) and depressive disorders. It considers in detail the mechanisms by which IL6 induces the clinical and laboratory manifestations of RDs and depression; the influence of precipitating and predisposing stress factors, including childhood mental traumas, which increase the risk of RDs and depression, on IL-6 production. Particular attention is paid to the consideration of prospects for using IL-6 inhibitors in the therapy of depression.


328-332 10

Chronic inflammation in rheumatoid arthritis (RA) is accompanied by local (periarticular osteoporosis) and generalized loss of bone mineral density in the axial and peripheral skeleton. The paper discusses the relationship between local and generalized bone loss and the contribution of various factors to bone changes. Information about the contribution of age at the onset of RA to the progression of destructive changes in the hands and feet and the rate of generalized bone loss in the axial and peripheral skeleton are contradictory.

333-338 22

In modern rheumatology, the problem of differential diagnosis of bacterial infection and active rheumatic process still retains its relevance. At the same time, it is very important to search for a biomarker - the gold standard for the diagnosis of an infection in patients with rheumatic diseases (RDs) in order to rapidly determine a treatment policy. This review analyzes the diagnostic significance and possibility of using some laboratory markers for bacterial infections in modern rheumatology. It emphasizes the importance of a multimarker approach that allows increasing the significance of individual parameters in the diagnosis of infections in RD.


339-344 9

Familial Mediterranean fever (FMF) is a monogenic autoinflammatory disease with a high prevalence in some countries. The carriers of the MEFV gene causing FML are Jews, Armenians, Turks, Arabs and other nationalities of Mediterranean origin. Crimean Tatars are one of the nations that inhabit the Crimean peninsula, who do not formally belong to Mediterranean populations. Until 2016, there were no data on FMF in Crimea among the Crimean Tatar population; however, 15 new cases of FMF have been diagnosed in the Republic of Crimea in the past 2 years. The paper provides data on FML patients and information about the ethnic origin of the Crimean Tatars, explaining the possible origin of mutant alleles in the population.


345-348 10

Chronic shoulder pain associated with subacromial impingement syndrome (SIS) is a common pathology that causes suffering and disability. One of the treatments for SIS is the local injection of hyaluronic acid (HA) preparations.

Objective: to evaluate the efficiency of subacromial injection of HA in chronic shoulder pain associated with SIS.

Subjects and methods. A study group consisted of 31 patients (48.4% of women and 51.6% of men; mean age 53.8±15.2 years) with chronic shoulder pain (>3 months) that had occurred after rotator tendon injury confirmed by ultrasound and/or magnetic resonance imaging. All the patients received two subacromial injections of 40 mg HA in 2 ml at a 7-day interval. The efficacy criteria were the changes of pain during movement (100-mm visual analogue scale (VAS)) and functional ability according to the ASES and CSC questionnaires at 1, 3 and 6 months.

Results and discussion. During the treatment, there was a considerable improvement in all measures. At baseline and 1, 3, and 6 months, the mean pain severity measured on VAS was 60.0±20.0, 40.0±25.4, 31.6±26.0, and 32.2±26.5 mm (p<0.001), the mean ASES scores were 53.64±16.43, 70.08±17.70, 86.13±12.86, and 82.69±27.88 (p<0.001); the mean CSC scores were 52.38±21.1, 66.26±20.83, 73.9±24.14, and 76.1±25.02 (p<0.001) respectively. No serious adverse events were noted.

Conclusion. Subacromial injection of HA is an effective and safe treatment for chronic shoulder pain associated with SIS.


349-355 16

Rheumatoid nodules (RNs) are one of the most common extra-articular manifestations of rheumatoid arthritis (RA), but are rarely located in lung tissue. The development of extra-articular (systemic) manifestations of RA is associated with the high levels of rheumatoid factor and anticyclic citrullinated peptide antibodies. The specific features of the course of RNs in lung tissue are their frequent occurrence with minimally pronounced joint inflammatory changes or remission. In rare cases, RNs are prone to disintegration and suppuration, which may be complicated by the formation of small caverns, hemoptysis, and, if located subpleurally, pneumothorax. In addition, there are publications on the possible relationship of the formation of RNs and their accelerated development to the administration of immunosuppressive drugs (methotrexate, tocilizumab, D-penicillamine, gold salts, leflunomide, infliximab, and other TNF-α inhibitors) and on the association of pulmonary RNs with methotrexate treatment. The paper describes a clinical case of a female patient with RA-systemic sclerosis overlap syndrome and RN formation in lung tissue early at disease onset when the DAS28 target level for RA has been achieved. The atypical outline of a pulmonary nodule has required a differential diagnostic search. The results of imaging RNs in the lung and their dynamics are shown. The given data are discussed.


356-357 17

The authors comment on the discussion article «Definition of the term “rheumatology”: do we need this and how do the EULAR and the ACR look at this?» by Sh. Erdes.



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