Objective. To study body composition phenotypes, the frequency of osteoporosis (OP), sarcopenia (SP), and obesity in postmenopausal women with rheumatoid arthritis (RA).

Material and methods. 99 women (aged 40-75 years) with RA were enrolled in the study. All patients were interviewed using a special questionnaire. Anthropometric measurements and muscle strength determination were also peiformed. Bone mineral density and body composition were assessed with dual energy X-ray absorptiometry.

Results. The frequency of OP was 31.3 % and the confirmed SP was 21.2 %. Isolated osteopenic phenotype was found in 14.1 %, osteosarcopenia - in 6.1 %, isolated sarcopenic phenotype - in 2.0 %, and phenotypes with obesity (osteopenic obesity, osteosarcopenic obesity and isolated obesity) - in 70.7 % of patients. Only 7.1 % of women had healthy phenotype.

Conclusion. Patients with RA had combined phenotypes of body composition more often than isolated ones. Phenotypes with obesity determined by densitometry were the most common.

In the presented article contemporary conceptions of genetics and clinical aspects of familial Mediterranean fever (FMF) used to termed ‘Periodic disease’ and being the commonest form of autoinflammatory syndrome have been discussed. Great attention is paid to gen MEFVpathogenic mutations, which are associated with sever FMF clinical manifestation. FMF characteristic clinical picture, criteria for diagnosis in children and adults as well as classification criteria Eurofever / PRINTO (2019) for FMF, considering genetic marker as major criterion, have been presented. Management of FMF according to EULAR recommendations (2016) based on traditional use of colchicine and alternative treatment with IL-1 inhibitors is analyzed. Brief review of clinical data and results of randomized trials have demonstrated high efficacy and safety of canakinumab in resistant FMF as well as in secondary amyloidosis treatment.

Rheumatoid arthritis (RA) is an autoimmune rheumatic disease of unknown etiology, characterized by chronic erosive arthritis (synovitis) and that can involve other tissues and organs. The use of biologics in clinical practice, including humanized monoclonal antibodies (IgG1) to interieukin-6 (IL-6R) receptors, it's the cause to search for predictors of response to this therapy.

The aim of this study was to determine the relevance of multiplex cytokine analysis in evaluating the effectiveness of tocilizumab (TCZ) in RA.

Materials and methods. We examined serum samples from 43 patients with RA. The comparison group was 297 healthy subjects matched by gender and age. Serum concentration of IgM and IgA rheumatoid factors (RF) and C-reactive protein (CRP) in serum was measured by immunonephelometry; of antibodies to cyclic citrullinated peptide (anti-CCP), antibodies to modified citrullinatedvimentin (anti-MCV), matrix metalloprotinase-3 (MMP-3) - by enzyme-linked immunosorbent assay; of cytokines - by xMAP technology.

Results. At week 4 on TCZ therapy, patients with RA had a decrease serum levels of CRP, IgM RF, AMCV, MMP-3; on 8th - ESR, CRP, IgM and IgA RF, anti-CCP and anti-MCV, on the 24th - of all biomarkers, excluding anti-CCP. At 4th, 8th, 24th weeks of therapy, there was a decrease in serum levels of all studied cytokines (excluding IL-6 at 4th week and IL- 1ra at 8th and 24th weeks). The most associated factors witch effectiveness of TCZ are: MMP-3 (AUC0.7), anti-CCP (0.7) and VEGF (0.7). A predictive model based on the assessment of serum levels of this biomarkers can predicting the clinical response to TCZ in RA (AUC = 0.85; CI: 0.7-1.0).

Conclusion. The data about association of basal serum concentrations of anti-CCP, MMP-3 and VEGF with the response in RA patients, made it possible to create a multiparameter index for predicting the TCZ effectiveness.

In recent decades, there has been clear progress in rheumatology associated with the introduction of genetically engineered biological drugs, as well as targeted basic anti-inflammatory drugs (tBPVP), which include Janus kinase inhibitors. At the same time, the use of these drugs is associated with an increasing risk of developing infections of various nature and localization, as well as reactivation of latent infection. In addition, cases of severe infections, including fatal ones, are registered. This review analyzes the literature data, mainly from the last 5 years, concerning the frequency and localization of major comorbid infections in patients with rheumatoid arthritis and psoriatic arthritis in the treatment of various tBPVS (tofacitinib, baricitinib, upadacitinib). The significance of infections (tuberculosis, herpes-viral infections, chronic viral hepatitis B) in the management of these patients is characterized. The need for a wider use of various vaccines (primarily anti-pneumococcal and anti-influenza) in patients with immuno-inflammatory rheumatic diseases is emphasized.

Polymyositis (PM) and dermatomyositis (DM) are autoimmune diseases, the main manifestation of which is symmetric muscle weakness of the proximal limbs, associated with inflammation of the striated muscles. Some PM/DM patients have pulmonary involvement and positive antisynthetase antibodies (ASA). The presence of ASA in PM/DM characterizes the unique phenotype of antisynthesis syndrome (ASS), which has a high risk of developing interstitial lung disease (ILD). Diagnosis of ASS is very difficult due to the large variability of clinical signs, which may include myositis, ILD, arthritis, Raynaud's phenomenon, ‘mechanic’s’ hand, skin rash, fever. There are two clinical observations of ILD in PM and DM in this article, showing the dynamics of symptoms for several years and difficult diagnosis of these diseases.

Behcet's disease (BD) is a rare systemic vasculitis, whfch affects vessels of different size. BD is diagnosed in the presence of recurrent aphthous stomatitis, combined with any two or more manifestations: genital ulcers, eye and skin damage and a positive pathergy testing, as well as the presence of positive HLA-B 51 test. This article describes the clinical case of a patient with Behcet's disease, who has a family aggregation of the disease, a wave-like course, and the gradual involvement of new systems. Authors have considered not only the development of clinical symptoms and the dynamics of the course of the disease, but also have presented algorithms for BD diagnosis and treatment in this patient, which had been based on the current national and international clinical recommendations focusing on the therapy impact on the prognosis in BD.

Objective. Evaluation of the incidence of fibromyalgia (FM), enthesitis (En), synovitis and tenosynovitis and other rheumatic diseases of the joints among patients with psoriasis (PsO) in the early stages after the onset of musculoskeletal symptoms based on a comprehensive study using clinical laboratory, X-ray and ultrasonographic methods.

Subjects and methods. The study is based on the analysis of survey data from 178 patients with PsO for the period of 2016-2019 years, among which was identified a group of 86 patients who had pain symptoms in the area of joints and tendon-ligamentous apparatus. The duration of the period of musculoskeletal pain in the observed patients did not exceed 6 months. In addition to general clinical and laboratory examination, all patients underwent an investigation for the presence of trigger points and ultrasonography of painful and/or swollen joints, tendons and ligaments on palpation using a linear sensor (frequency of 12-18 MHz) using the Esaote MyLab 50 apparatus and supplemented by Doppler energy study with a pulse frequency of 6.6 MHz.

Results and discussion. Based on the data of a comprehensive examination of the observed patients with PsO, the diagnosis of PsA was established in 29.78 %, osteoarthritis - in 6.18 %, gout -in 3.93 %, fibromyalgia - in 11.24 % of cases. Ultrasonographic signs of En were found in 29.78 %, isolated En was found in 10.67%, a combination of En and synovitis - in 14.04%, a combination of En and tenosynovitis - in 8.99% of patients. Isolated FM was diagnosed in 8.9%, a combination of FM, En and synovitis - in 4.2 % of patients. In patients with FM, in comparison with patients with clinical and ultrasonographic signs, lesions of the scalp, neck and face and palmar-plantar localization were more often observed and, less often, of the upper and lower extremities. Ultrasonographic signs of structural damage to enthesises were observed in 17.4% of patients without clinical and ultrasonographic signs of active EN, which may indicate the possibility of a subclinical course of enthesial inflammation in patients with Ps O.

Conclusion. In the early period of involvement of the musculoskeletal system in patients with PsO, the frequency of PsA was 29.78%, isolated FM - 8.9%, isolated EN - 10.67% of cases. The data on the features of skin lesions in patients with various types of lesions of the musculoskeletal system were obtained.

The article presents literature data analysis on the incidence, diagnosis and prevention of thromboembolic, cardiovascular, infectious complications of large joint arthroplasty in patients with rheumatoid arthritis in postoperative period. The results of studies focusing on the peculiarities of preoperative examination and anesthetic management in this category of patients are presented. The necessity of an individual approach is shown, taking into account the surgical intervention type, the presence of comorbidity, the infectious and thromboembolic complications risk degree, as well as concomitant pharmacological therapy.