This article presents analysis of current data highlighted the problem of pathogenic mechanism of the most common spondyloarthritides (SpA) and focused on the pivotal role of interleukin‑17 in immune inflammation realization. Contribution of IL‑17 in mechanism of SpA particularly in different organ damage, in perpetuation of chronic inflammation and in structural progression is discussed. The clinical and experimental evidence of close relationship between IL‑17A levels, on one hand, and disease activity, high tempo of joint and bone affection as well as SpA extra-articular manifestations, on the other, are presented. Contribution of cell-mediated immune response including activated IL‑17A-producing cells to the pathogenesis of different SpA phenotypes is shown. Great attention is paid to the clinical effects of IL‑17A inhibition in Sp A. The results of clinical trials of novel IL‑17A inhibitor netakimab in the treatment of ankylosing spondylitis are presented. These data have demonstrated high efficacy and safety of tried preparation used in the regimen 120 mg per 2 weeks. On the basis of performed analysis the key role of IL‑17 in SpA pathogenesis is confirmed and expediency of SpA target therapy with novel IL‑17A inhibitor netakimab is justified.

Objective. To study the bone mineral density (BMD) and appendicular muscle mass (AMM), their interrelation and relationship with calcium intake and vitamin D level in women with rheumatoid arthritis (RA).

Material and methods. 43 women (mean age 57.5 ± 7.0 years) with confirmed RA were included. All patients were interviewed using a special questionnaire. Dual-energy X-ray absorptiometry (DXA) of lumbar spine, hip and total body was performed, and dietary calcium intake and vitamin D blood serum levels were assessed.

Results. Reduced BMD was detected in 76.8% of patients, including osteoporosis (OP) – in 23.3%, and osteopenia – in 53.5% of women. Low AMM was found in 11.6%, and reduced appendicular muscle index (AMI) was found in 18.6% of the examined patients. Women with low BMD had significantly lower AMM and AMI scores than patients with normal BMD. The average calcium intake was 737 mg per day, while it was lower in patients with OP compared to those with normal BMD (p = 0.038). Among all women, 56% of individuals needed additional calcium supplementation. The average level of vitamin D in the blood serum was 20.8 ng/ml, with the incidence of insufficiency – 48.8%, and deficiency – 41.9% without significant differences between individuals with OP, osteopenia and normal BMD.

Conclusion. In women with RA, reduced BMD was found in 76.8%, reduced AMM – in 11.6%, and low AMI – in 18.6% of cases. Patients with low BMD had lower AMM and AMI than women with normal BMD. Calcium intake was significantly lower in patients with OP compared to those with normal BMD.

The literature review presents data on existing treatments for psoriasis (P) and psoriatic arthritis (PsA). The relevance of the work is rationale with the difficulties of choosing a particular therapeutic agent by a specialist, depending on the peculiarities of the course of the skin pathological process, damage to the musculoskeletal system, spine and related diseases. Synthetic and targeted drugs are described in a chronological consequences, the review provides accumulated information about their effectiveness in relation to various manifestations of P and PsA, and the safety of their use. In conclusion, current recommendations on the differentiated use of various agents for target therapy based on a comprehensive assessment of the clinical characteristics of patients as well as mechanism of action and side effects of the drugs, are discussed.

Summary In modern rheumatology, the problem of comorbid infections (CI) still remains relevant. This is due to both the presence of autoimmune rheumatic disease and the need to use immunosuppressive drugs. This article discusses some issues of CI in psoriatic arthritis (PSA). The frequency of CI in the treatment of conventional synthetic disease-modifying antirheumatic drugs and biologics was analyzed. The significance of preventive measures in relation to CI in the treatment of PSA is shown.

The presence of combined joint contractures, the development of secondary protrusive coxarthritis (PC), severe osteoporosis and bone destruction in patients with rheumatoid arthritis (RA) and spondyloarthritis produce a number of technical difficulties during the implementation of total hip arthroplasty (THA). In this article we have presented a clinical case of bilateral cementless THA performed in a patient with RA and secondary PC. Before surgery the functional Harris score was 20 points, and the DA-S28 (disease activity score) was 3.1. The patient had PC of the third degree on the right and the second degree on the left side. During THA on the right side we applied the technique of impact bone autoplasty. Four years after surgery, the functional Harris score was 73; DAS‑28 was 2.7. Thus, the combination of conservative therapy and surgical treatment improves patient's clinical and functional state and also helps to maintain low activity of RA.

Purpose of the study. Assessing the association between the life quality of patients with Sjogren’s Disease and ongoing therapy with various disease-modifying antirheumatic drugs.

Material and methods. The study was conducted on the basis of the regional rheumatology center of the consultative diagnostic clinic of the Sverdlovsk Regional Clinical Hospital No. 1. This work is based on the results of a simultaneous study of 74 patients with primary Sjogren’s Disease (SD), distributed in three comparison groups receiving various disease-modifying antirheumatic drugs chlorambucil, methotrexate and hydroxychloroquine. The diagnosis of SD was carried out according to European-American criteria AECGC (2002) [18]. In order to analyze the quality of life of patients with SD, the 36-Item Short Form Health Survey (SF‑36) was used. Statistical data processing was carried out using Statistica 7.0 program.

Results. Assessment of the quality of life of patients with SD, which is an integrative criterion of human health and well-being, revealed the absence of statistically significant differences (p > 0.05) on eight scales and two health components of the SF‑36 questionnaire in the analyzed groups that differ in the treatment of disease-modifying antirheumatic drugs chlorambucil, methotrexate and hydroxychloroquine.

Conclusions. The obtained data indicate an equivalent quality of life in SD patients treated with different disease-modifying antirheumatic drugs methotrexate, chlorambucil and hydroxychloroquine, and therefore hydroxychloroquine can be considered as an alternative basic therapy in patients with SD with certain limitations and contraindications methotrexate and chlorambucil.

The development of atherosclerosis is closely related to the calcification of the vessel intima and fibrous plaques, being a complex and multifactorial process, in which the markers of bone formation and resorption play an important role. Objective. To study the biochemical markers of bone metabolism in men with stable coronary heart disease (CHD). Material and methods. The study included 102 men with verified CHD. Data were evaluated by densitometry, coronary angiography, multispiral computed tomography, color duplex scanning of brachiocephalic arteries, serum lipids (total cholesterol, triglycerides [TG], high-density [LHD] and low-density lipoprotein cholesterol), concentrationsin the blood of osteocalcin (OC), bone alkaline phosphatase (BAP), cathepsin K and C-telopeptides (CTx). Results. Concentrations of BAP, cathepsin K and CTx in patients with CHD were significantly higher than in men without CHD. The concentration of OC in men with normal bone mineral density was significantly lower than in patients with osteopenic syndrome. There was a direct correlation between OC and antiatherogenic HDL cholesterol and the inverse correlation between OC and TG, CTx and TG. There was no correlation between the level of bone remodeling markers and coronary artery (CA) lesion variant and the severity of coronary atherosclerosis on SYNTAX scale. The correlation analysis did not reveal the connection of biochemical markers of bone metabolism with the severity of coronary atherosclerosis and calcification and thickness of intima-media complex of carotid arteries. Absolute values of bone formation indices (BAP, OC) were significantly higher in patients with severe СA calcification than in patients without signs of calcification. Summary. Increased rates of osteogenesis and osteoresorption characterize the accelerated process of bone metabolism and indicate in favor of high rates of bone loss in men with CHD, which confirms the likelihood of common pathophysiological mechanisms of bone resorption and arterial calcification.

The development of renal dysfunction in patients with rheumatoid arthritis (RA) is due to the presence and severity of autoimmune disorders, chronic systemic inflammation, a multiplicity of comorbid conditions, and pharmacotherapy features. The most important parameter that describes the general condition of the kidneys is glomerular filtration rate (GFR). This review presents the data on the possibilities of modern methods for determining estimated GFR (e-GFR) and the specificity of their use in various clinical situations that accompany the course of RA. For the initial assessment of GFR in patients with RA it is advisable to use the measurement of e-GFR based on serum creatinine concentration using the CKD-EPI equation (2009) (with or without indexing by body surface area). In cases where the e-GFR equations are not reliable enough or the results of this test are insufficient for clinical decision making, the serum cystatin C level should be measured and the combined GFR calculation based on creatinine and cystatin C should be used.

Objective. To assess the relationship between ultrasound and clinical characteristics of psoriatic arthritis (PsA) and osteophytes detected by ultrasound (US).

Methods. Data collection: demographical, clinical, antropometric (body mass index, BMI). US examination included 868 joints and 3348 entheses (bilateral shoulders, acromioclavicular joints, elbows, wrists, hips, knees, ankles; entheses at the projection of these joints (total number is 54). In the joints – synovitis count, Power Doppler (PD) + synovitis count (SC), the number of joints with osteophytes; in entheses – Grey Scale (GS) enthesitis count (EC), PD + EC, count of entheses with structural components (erosion, enthesophytes, calcification).

Results. In all, 62 PsA patients were examined: 32 (51.6%) were women, mean age was 43.0 ± 10.4 years, the duration of PsA was 7 (3; 10) years. The number of joints with osteophytes was 314 of 868 (36.2%). US osteophytes were detected in 51 (82.3%) patients. The number of joints with osteophytes correlated with GS EC (r = 0.398; p < 0.01), PD + EC (r = 0.302; p < 0.05), SC (r = 0.425; p < 0.01), and PD + SC (r = 0.322; p < 0.05). Patients without osteophytes, with local and generalized osteophytes were comparable by sex and duration of the disease. In patients with generalized osteophytes, GS EC (p < 0.05), PD + SC (p < 0.05), SC (p < 0.01), comorbid pathology (p < 0.05), BMI (p < 0.05) were significantly higher.

Conclusion. The frequency of osteophytes in patients with PsA was high. The number of synovitis and enthesitis, both GC and PD+, was more common in patients with generalized osteophytes, which probably suggests an important role of entheseal and synovial inflammation in PsA in the development of osteophytes. BMI and the frequency of comorbidities in patients with generalized osteophytes were higher.