Background. Rheumatic diseases (RD) of autoimmune origin are considered as an important risk factor for infectious processes due to characteristic native immune system disorder, as well as due to the adverse effect of immunosuppressants and glucocorticoids on the mechanisms of anti-infective protection.

Aim. To highlight the problem of RD and concomitant viral infection which becomes critical in the era of COVID‑19.

Results. According to the current national guidelines for the management of patients with COVID‑19, patients with RD represent an increased risk group for the adverse course of coronavirus infection. Presented article provides basic information on the use of interleukin‑6 (IL‑6) inhibitors in patients with COVID‑19 focusing on the benefit of this therapeutic option in those with prior RD. The article presents an analysis of two clinical cases demonstrating high efficacy and good tolerability of levilimab (Ilsira®) in the treatment of coronavirus pneumoniae in the setting of autoimmune diseases: polymyositis (PM) and rheumatoid arthritis (RA).

Conclusion. Our own clinical experience confirms the feasibility of including an IL‑6 receptor inhibitor in the treatment regimen for coronavirus pneumonia in patients with RD characterized of immune inflammation.

The article presents the issues of arthroplasty of several large joints in rheumatoid arthritis (RA), including the difficulties of perioperative management of young patients. The effectiveness of arthroplasty of several (from 2 to 4) large joints is shown in the management of patients with RA at the orthopedist and rheumatologist. Тhe absence of serious postoperative complications was demonstrated. The article presents а 20-year clinical case of a young patient with active RA and arthroplasty of 4 large joints. This example demonstrates the success and safety of multiple arthroplasty with a complete return of joint function and a decrease in RA activity during long-term dynamic follow-up at the orthopedist and rheumatologist.

In accordance with the recommendations of EULAR and ARR methotrexate (MTX) is the first-line drug in patients with rheumatoid arthritis (RA). In cases where the use of MTX is impossible due to its ineffectiveness or adverse drug reactions (ADRs), leflomide (LEF) or sulfasalazine is most commonly used in routine clinical practice. This article presents generalized data on the safety of LEF in the treatment of patients with RA. It was shown that ADRs associated with the LEF were most often met in the first year of treatment. The most frequent ADRs were arterial hypertension, hair loss, diarrhea, dermatitis of different localization, increasing the level of transaminases, pancytopenia and others. 

Background. Osteoporosis is a common pathology among older age groups. Vertebral fractures are one of the most severe complications of osteoporosis, as they lead to a decrease in the quality of life, disability and increased mortality. The risk of vertebral fractures increases with age, especially in those who have already has a fracture of this localization. To improve the prognosis in this category of patients, early detection, treatment of patients with fractures, as well as prevention of new fractures, are important. At the same time, the diagnosis of osteoporotic vertebral fractures presents certain difficulties due to the variability of their clinical manifestations, which often leads to insufficient detection, wrong diagnosis and, as a consequence, to the lack of adequate treatment.

Purpose of the review. To conduct a literature search to evaluate the clinical diagnosis of osteoporotic vertebral fractures.

Conclusion. There was no single highly specific and at the same time sensitive clinical symptom of osteoporotic vertebral fractures. Back pain remains a relatively nonspecific symptom in vertebral fractures. The most specific symptoms: kyphosis and height loss have a high predictive value only when they are significantly changed. Thus, vertebral fractures should be suspected if height decreased more than 2.0 cm per year or more than 4.0 cm per life, if the patient does not reach the wall with his head or if the «rib to pelvis» distance is two fingers or less. The combination of clinical symptoms with the assessment of risk factors and bone mineral density has the greatest clinical significance. If a vertebral fracture is clinically suspected, it is advisable to perform an X-ray of the thoracic and lumbar spine, since the localization of pain indicated by the patient may not correspond to the localization of the fracture.

Drug-induced lupus syndrome (DLS) is a rare adverse event with a variety of drugs. More than a hundred of drugs are known that can cause the development of DLS, and this list is growing as new drugs appear. Physicians of any specialty can face such complications of therapy and should be aware of this pathology. The article presents an analysis of a clinical case of DLS development against the background of long-term administration of sulfasalazine in a patient with a reliable diagnosis of rheumatoid arthritis, as well as a literature review, which includes data on the prevalence, drug groups, clinical manifestations, diagnosis and treatment of this pathology.

Obesity is a risk factor for many chronic diseases. Several research methods are used to determine the amount of body fat, including the «gold standard» dual-energy X-ray absorptiometry (DXA). The bioelectrical impedance analysis (BIA) method is an alternative for assessing body composition that does not require special conditions for placement and examination, but the accuracy of its results depends on the hydration of the body.

Objective. To compare the results of determining the percentage of body fat using multi-frequency (MF) BIA and DXA.

Material and methods. The study included 20 volunteers (11 women and 9 men) aged 26 to 70 years without serious metabolic, cardiovascular or endocrine diseases. Two repeated measurements were performed using the MF-BIA method on the MS FIT device and the DXA method on the Lunar Prodigy Advance device.

Results. There were no significant differences in the average percentage of body fat in repeated measurements by MF-BIA and DXA methods, and the intra-group correlation coefficients (r2 ) were 0.999 and 0.997, respectively. A high and significant correlation in percentage of body fat was found between the MF-BIA and DXA (r = 0.973, p < 0.001). The average difference between the results of these two methods was 0.1243%. Differences in percentage of body fat that exceeded two or more standard deviations were detected less than in 5% cases, so the data on body fat content estimated using DXA and BIA are consistent and can be considered almost equal.

Conclusion. Our study has shown that the MS FIT body composition device using the MF-BIA method can be an alternative to DXA for assessing the percentage of body fat without introducing additional formulas to recalculate the data obtained.

Rheumatoid arthritis is the most common rheumatic disease characterized by damage to the synovium, progressive destruction of cartilage and bone tissue. As a result of the establishment of the biological role of cytokines, it became possible to intervene in the main links of the pathogenesis of the disease, which led to inhibition of the main pathological process in RA – autoimmune inflammation.

The aim. To consider the possibilities of optimizing the biological therapy of rheumatoid arthritis by identifying predictors of anti-inflammatory efficacy among clinical and laboratory markers.

Basic provisions. Despite the success of genetically engineered biological drugs in the treatment of inflammatory arthritis, due to the lack of predictive biomarkers, the use of a trial and error approach, empirical therapy, is inevitable, which does not always lead to satisfactory results. The study of the main biomarkers of RA provides new insights into their potential association with various clinical phenotypes.

Conclusion. This patient-centered approach offers the prospect of improving treatment outcomes through the use of specific drugs in certain patient groups.

Background. Osteoporosis (OP) and its consequences is a pivotal medical and social problem. Rheumatic diseases especially rheumatoid arthritis (RA) is considered a key factor in the development of secondary OP. At the same time, patients with RA also have traditional risk factors (RF) for OP, as well as the adverse effects of drugs on bone metabolism. Consideration of the full spectrum in each patient with RA plays an important role in the individualized assessment of the risk of OP and the rational management.

The aim. To analyze the most significant RF of OP in a cohort of patients with verified RA observed by primary care specialists.

Materials and methods. Medical cards of 100 patients with determined RA (ACR / EULAR criteria) who were observed at out-patient clinics were studied. Along with the analysis of the clinical manifestations of RA, the registration of OP RF, both traditional and disease-related, was carried out with an analysis of the prevalence of RF in the investigated cohort.

Results. The RA cohort under study was dominated by patients with erosive arthritis, disease duration of more than 5 years, RF and/or ACCP positivity, moderate activity, functional class 2–3. Based on the available instrumental data, systemic OP was diagnosed in 33% of patients, while DXA-densitometry was performed only in 5% of patients with osteoporotic fractures. Among the traditional RF, the most significant were female sex, age higher than 50 years, BMI less than 20 kg/m2 . The frequency of registration of these RF was significantly higher in the subgroup of patients with confirmed OP. Of the disease-associated RF, the most common were the following: duration of RA more than 5 years, activity of 2–3 degrees, high titer of RF and ACCP, X-ray stage II and higher, long term systemic GC use.

Conclusions. In real practice, the diagnosis of OP in primary care in patients with RA is based on the available instrumental methods, preferably on standard radiography of bones and joints, which leads to underestimation and/or late diagnosis of OP. Patients with RA have a wide range of traditional and specific OP RFs, the assessment of which is important for determining the risk of fractures and timely prevention of OP complications.

Aim. To compare the concentration and immunogenicity of TNF-α inhibitors (TNFi) and their relationship with efficacy in patients with rheumatic diseases (RD) and inflammatory bowel diseases (IBD).

Materials and methods. The study included 104 patients with RD (48.1%) and IBD (51.9%) who received infliximab (INF, 30.8%), adalimumab (ADA, 38.5%) and certolizumab pegol (CZP, 30.8%). We assessed the efficacy of the drug, trough concentration of TNFi and the level of antibodies. In 30 patients, the concentration of TNFi and the level of antibodies were assessed twice with an interval of 15 [13; 17] months.

Results. TNF-α inhibitors were effective in 77 (74%) patients. In the group of IBD and RD, the incidence of inefficiency was 33.3% and 18.0%, the ineffectiveness of CZP was found only in IBD group (p = 0.024). A low concentration of TNFi was detected at the first visit in 29 (53.7%) patients with IBD and 24 (48.0%) with RD, at the second visit in 4 (36.4%) patients with IBD and 9 (47.4%) with RD. In all patients with RD who did not respond to IFN and CZP, the subtherapeutic concentration was determined (p = 0.047), in the IBD group – only in 64.3% cases (p > 0.050). At the first visit, antibodies to TNFi were found in 24 (23.1%) patients, at the second visit in 7 (23.3%) exclusively in the RD group (p = 0.019), in 5 of them repeatedly. The formation of Ab was associated with 27.8% of cases of escape of the effect of TNF-α in IBD and 22.2% of cases of ineffectiveness in RD (p > 0.050).

Conclusions. The incidence of TNF-α efficacy did not differ between RD and IBD, CZP ineffectiveness was observed exclusively in patients with IBD. In patients with RD, a significant relationship was found between ineffectiveness and low concentration of TNFi. The frequency of Ab formation did not differ between the groups of diseases.

Objective. Study the state of mineral bone density (BMD) in postmenopausal women with osteoarthritis (OA) of the knee joint depending on the X-ray stage.

Materials and methods. The study included 56 women between 44 and 75 years of age. The diagnosis of OA is established according to the diagnostic criteria of the American College of Rheumatology (ACR, 1991). For comparative analysis, patients were divided into two groups, taking into account the radiological stage: the 1st with 38 women with I–II radiology stage, the 2nd with 18 patients with III–IV radiology stage. The X-ray of the knee joint in the anterior projection is performed in a fixed bending position using a special frame (SynaFlexer TM Plexiglass positioning frame, Synarc Inc., USA). The BMD is estimated by a two-energy X-ray absorption technique in the femoral neck and lumbar spine.

Results. Osteopenic syndrome is diagnosed in 52 (92.8%) of the total number of patients, 27 (48.2%) have osteopenia and 25 (44.6%) have osteoporosis. Four women (7.1%) have a normal BMD. There is no statistically significant difference in the frequency of detection of the osteopenic syndrome between the groups studied (p > 0.050). Statistically significant increases in BMD and T-criteria have been found as the OA progresses in both the femoral neck and the lumbar spine. The correlation analysis results show a significant positive correlation between the BMD femoral neck and the OA X-ray stage (r = 501; p < 0.001).

Conclusions. The data show the presence of the osteopenic syndrome in the vast majority in postmenopausal women with OA of the knee joint. The high BMD values of the femur neck and lumbar spine are associated with the late X-ray stages of the OA of the knee joint.