The article is devoted to the study of bone mineral density (BMD) in women of reproductive age suffering from rheumatic diseases (RD). A survey was conducted of 134 women — 94 patients with RD (rheumatoid arthritis, systemic scleroderma and psoriatic arthritis) and 40 people without RD. Reduced BMD was detected significantly more often in the group of patients with RE compared with the healthy control (25 and 8 %, respectively; p = 0.0213). Patients with RD showed a direct association of BMD values in all measurement areas with height, weight, body mass index, serum vitamin D concentration, and the reverse — with a cumulative dose of glucocorticoids; For MPC of the proximal femur, an additional relationship was revealed with the duration of RD. Thus, a quarter of women with RD in reproductive age need to be monitored, and in the presence of fractures, treatment of osteoporosis.

Background. Аnkylosing spondylitis (AS) is closely associated with inflammatory bowel disease (IBD). 5–10 % of patients with SpA eventually develop inflammatory bowel disease, with Crohn's disease being more common than ulcerative colitis. Colonoscopy is usually used to diagnose inflammatory bowel disease, but this procedure is invasive. FC is clinically used to detect IBD and correlates well with clinical, endoscopic, and histological indicators of disease activity in IBD.

The aim. To evaluate the incidence of inflammatory bowel disease in patients with ankylosing spondylitis.

Materials and methods. In the analysis were included 40 patients with ankylosing spondylitis, among them 26 (65.0 %) men, and 14 (35.0 %) women, the average age of patients was 41.2 ± 10.5, the duration of the disease was on average 13.0 ± 8.8 years. All patients were examined with ESR, CRP, esophagogastroduodenoscopy, colonoscopy and quantitative analysis of the fecal calprotectin levels using the method of lateral immunochromatography with the BUHLMANN Quantum Blue rapid test. Standart range: 100–1,800 µg/g.

Results. All patients had a high disease activity, the average BASDAI was 5.2 ± 1.7, the average ASDAS CRP 3.8 ± 1.1. 35 (87.5 %) patients had calprotectin level more than 100 µg/g, the remaining 5 (12.5 %) patients less than 100 µg/g. 12 (30.0 %) patients had the calprotectin level more than 1,800 µg/g, 23 (57.5 %) from 101 to 1800 µg/g. All patients with FC levels more than 100 µg/g showed an increase CRP level (mean 28.4 mg/l) and ESR (mean 36.3 mm/h). IBD were diagnosed in 9 (22.5 %) cases: 5 (12.5 %) patients with Crohn's disease and 4 (10 %) patients with ulcerative colitis, in the remaining (77.5 %) cases there was no intestinal pathology.

Conclusion. The results showed high frequency of IBD in patients with AS. Patients with high fecal calprotectin levels (more than 100 μg/g) had high disease activity (AS). In most cases, inflammatory bowel disease were diagnosed in patients AS with fecal calprotectin levels more than 100 µg/g.

The article contents the analysis of different clinical phenotypes in the most common spondyloarthritis (SpA): ankylosing spondylitis (AS), axial spondylarthritis (axSpA) and psoriatic arthritis (PsA). SpA polymorphism has been discussed on the basis of multiple clinical presentations, structural lesions, radiological, immunological and genetic characteristics. Role of pro-inflammatory agents especially IL-17 in structural progression has been pointed out. Recent data regarding the link between HLA-B27 antigen, gender and age specificity and different clinical manifestation of SpA are presented. Current algorithms for SpA management based on evidence of efficacy sDMARD and/or biologics in separate phenotypes of SpA as well as resistance to DMARD are highlighted. Authors have concluded that meticulous analysis of SpA manifestation and patient’s individual profile is critical in rational SpA management according to personified medicine strategy.

Dual-energy X-ray absorptiometry is recognized as the ‘gold standard’ for the diagnosis of osteoporosis. This method is used not only for the initial assessment of the state of the IPC, but also for further monitoring of treatment or preventive measures. It allows you to compare the data of a patient with successive measurements during a long observation. However, it is impossible to evaluate the results of studies in dynamics on devices of different manufacturers without standardizing indicators or introducing correction factors. A simple method for recalculating the T-score obtained on a Dexxum 3 apparatus (OsteoSys, South Korea) is presented in order to compare it with a similar indicator of a bone densitometer Lunar Prodigy (GE Healthcare, USA).

Takayasu arteritis (TA) is a rare disease. Due to the variety of clinical manifestations the patients may primarily apply to general practitioner or other specialist.

Aim. To assess the awareness of primary care physicians and outpatient department specialists of TA clinical manifestation, diagnosis criteria and treatment issues.

Methods. 200 physicians consented to take part in a survey. The study sample included 50 internists, 25 neurologists, 21 gastroenterologists, 18 rheumatologists, 28 cardiologists, 45 pediatricians, 13 nephrologists practicing at the outpatient departments of the city of Yekaterinburg and Sverdlovsk region.

Results. Among the related specialists, the most freuent incorrect answers were given on intermittent claudication (48 % correct), involved arteries (49 %). Rare application of TA diagnostic criteria (32 %), low awareness of the TA diagnostic standard (39 %) was found. The survey results confirm previously reported data on the low awareness of TA by primary care physicians.

Conclusion. This is the first study to assess the primary medical service specialists awareness in the Russian Federation. Diagnosis and treatment of TA should be included in a number of educational programs and resources for continuing vocational education.

A comparative analysis of the clinical, functional and radiological results of total hip arthroplasty (THA) in pts with primary osteoarthritis (PA) was carried out. The aim was to improve the results of THA in pts with degenerative diseases of the hip joint based on the choice of the optimal type of components fixation. The study included 125 patients (68 women, 57 men) with primary coxarthritis who underwent 125 operations of unilateral THA. All pts were divided into two groups depending on the type of components fixation. Group I (N = 63; average age 69.8 ± 3.1; from 34 to 75 years) included pts with cementless fixation (DePuy, Zimmer, titanium cups, titanium stems such as Corail and Zweymuller), in group II (N = 62; average age 67.2 ± 2.7; from 44 to 87 years) — with cement fixation (Zimmer, Smith & Nephew — low-profile Muller cup, Muller stem). Metal-polyethylene friction pair and head size 32 mm were used in all cases. Evaluation of the results was carried out on 2, 6 months, 1, 5, 10 years after the operation and included: functional state assessment (Harris Hip Score), radiographs analysis, as well as the frequency of complications and revision interventions. There were no significant differences in the incidence of deep periprosthetic infection, thromboembolic complications, hematomas, paraarticular ossifications, aseptic loosening, dislocations and revision interventions. There was faster positive dynamics in the early period (up to 6 months) when using cemented THA. Subsequently all the indicators were comparable in both groups. Osteolysis at the border of implant fixation was recorded in two cases in group I and in 11 cases in group II (p < 0,05). In group I, eight periprosthetic intraoperative fractures of the proximal hip were recorded; in group II, this complication was obtained in one pt (p < 0.05). Stress-shielding syndrome was detected in six pts from group I. This complication was not detected in group II (p < 0.05). Thus, both methods are comparable in results and can be equally applicable for the surgical treatment of patients with primary osteoarthritis, which can significantly expand the possibilities of specialized medical care and effective rehabilitation of this category of patients.

The article traced the main provisions on mechanism of action of slow-acting symptom-modifying drugs (SYSADOA): cartilage reparation, influence on nuclear factor κB, IL-6, IL-8, VEGF, transcription factor SOX9, etc. The effectiveness of SYSADOA drugs in the complex treatment of shoulder pain was evaluated. The inclusion of the bioactive concentrate from small sea fish (BCSSF) into the treatment regimen helps to reduce the number of recurrences of pain after the cancellation of non-steroidal anti-inflammatory drugs. We revealed a higher percentage of patients with significant pain reduction and restoration of the function of the shoulder joint in the group receiving BCSSF injections. The results of the study suggest the feasibility of including BCSSF in the complex scheme of treatment of pain in the shoulder joint.

In rheumatology in recent years, the importance of comorbid infections has increased significantly, especially in connection with the introduction of genetic engineering biological drugs into clinical practice. One way to solve this problem is to study and actively use various vaccines. This review provides an updated version of the recommendations for vaccinating adult patients with autoimmune inflammatory rheumatic diseases, proposed in 2019 by experts from the European Anti-Rheumatic League (EULAR). Issues regarding the use of influenza vaccines, infections caused by Pneumococci, Hepatitis B viruses, herpes and human papillomaviruses in rheumatological patients are considered. The main directions of future research on this issue are outlined.

Aim. To identify the causes of mortality in elderly and senile patients with non-traumatic hip fracture during the first year after fracture.

Materials and Methods. The reasons for death were analyzed in the cohort consisted of 432 patients with a non-traumatic hip fracture: 328 women aged from 70 to 82 years (mean age 75.4) and 104 men aged from 60 to 80 years (mean age 71.5).

Results. It was revealed that in first 6 months after the injury, death occurred in 22.00 % of cases (95 from 432 patients died). After 12 months period, mortality increased to 137 cases (total mortality accounted for 31.80 %). Most of the deaths were due to cardiovascular system diseases. Cardiovascular causes were in 93 cases (21.00 %), without any gender difference: 22 in men (21.10 %) and 71 in women 21.60 %). The ratio of cardiovascular diseases in the total number of fatal outcomes was 93 (67.80 %), comparable for men and women subgroups (66.00 and 68.30 % respectively; p = 0.65). Diseases of respiratory system as a reason for death accounted for 16.80 % in the structure of total mortality: 15.10 % in men subgroup and 17.30 % in women (p = 0.31). Mortality from tumors was defined in 10.90 % from all cases of death: in men 9.09 % cases and in women 11.50 % cases (p = 0.45). The ratio of digestive system disorders as the cause of death accounted for 3.60 %: 6.06 % in men and 2.90 % in women respectively (p = 0.1).

Conclusions. Cardiovascular and respiratory diseases were the most common causes of first-year mortality in elderly and senile patients with non-traumatic hip fracture. The gender differences in mortality rates were not found.

Background. Inflammation of the hip joints in ankylosing spondylitis (AS) is a frequent and severe manifestation of the disease, which in 7–8 % of patients is accompanied by the requirements of hip joints prosthesis. In the treatment of hip arthritis associated with AS non-steroidal anti-inflammatory drugs (NSAIDs), sulfasalazine (SSZ) and tumor necrosis factor-alpha blockers were used. However, the influence of these treatment on the dynamics of structural changes in hip joints is not studied.

Purpose. To evaluate the dynamics of clinical, radiologic and ultrasonographic indices of hip joints in patients with AS who take different treatment methods for 12 months: NSAIDs, SSZ and adalimumab (ADA).

Materials and methods. Dynamic monitoring of 78 patients with AS (corresponding to the New York modified criteria of 1984), who also had clinical, ultrasonographic and radiographic signs of inflammation of hip joints. The patients were divided into three groups: patients of the group 1 (n = 25) were been receiving NSAIDs; patients of group 2 (n = 26) had started to take SSZ (2–3 grams per day) on background of NSAIDs; patients of group 3 (n = 27) were started to take ADA (subcutaneously, 40 mg once every 2 weeks) on the background of NSAID. In addition to the generally accepted clinical and laboratory studies, all patients were being underwent by X-ray examination with an evaluation of the BASRI-Hip index and ultrasonography of hip joints during 12 months of follow-up.

Results and discussion. In patients of group 2 treatment with SSZ during 12 months had been resulted in a decrease in the severity of pain from the visual analogue scale (VAS) at hip joint motion (26.1 [13.9, 42.7] vs 69.3 [56.8, 79, 3]), CRP (4.4 [1.5, 6.9] mg/L vs 15.2 [8.3, 21.8] mg/L) and a decrease in the thickness of the hip synovial membrane (6.7 [5.8, 8.5] mm vs 9.6 [7.9, 11.8] mm) compared with the initial data. In patients of the group 3 treatment with ADA had been lead to decreasing of pain VAS (14.2 [5.2, 26.7], vs. 72.1 [65.3, 89.1], BASDAI and ASDAS_CRP (1.7 [1.1, 3.1] and 1.4 [1.1, 2.2] vs. 7.5 [5.9, 8.6] and 3.1 [2.6, 3.9]), CRP (2.7 [0.2, 5.8] mg/L vs. 24.3 [17.4, 35.9]) and decrease in the thickness of hip synovial membrane (6.3 [5.0, 7.7] mm vs. 9.9 [8.1, 12.6] mm) and an increase of the thickness of the hyaline cartilage covering the head of the femur in comparison with group 1 (0.15 [0.09; 0.22] mm vs. —0.08 [–0.12, —0.04] mm). The effect of both drugs on the dynamics of the radiographic index BASRI-Hip and the formation of new osteophytes in hip joints was not noted.

Conclusion. Inclusion of SSZ and ADA in a complex of treatment of patients with hip arthritis associated with AS leads to a decrease of synovitis of hip joints. Usage of ADA is accompanies by ultrasonographic signs of the restoration of hip joints cartilage.