Background. Lesions of extra-articular soft tissues occupy a leading place in the structure of diseases of the musculoskeletal system in primary health care. At the same time, insuffcient attention is paid to this pathology, which leads to a decrease in the quality of care for patients with extra-articular pathology.

Objective. Increasing the awareness of general practitioners about the clinical forms of extra-articular soft tissue diseases, current approaches to diagnosis and treatment.

Basic provisions. The article presents the characteristics of the main forms of periarticular lesions: periarthritis, incl. painful shoulder, tendonitis, tenosynovitis, capsulitis, bursitis. The leading mechanisms of periarticular disorders are presented, the clinical picture and diagnostic signs of particular forms are described. The role of modern methods of visualization of periarticular lesions using ultrasound and MRI is noted. The main approaches to the drug therapy of periarticular disorders are presented, including use of slow-acting symptom-modifying drugs (SYSADOA). The authors present their own data demonstrating the connective tissue metabolism disturbance in periarticular disorders as well as the effectiveness of the drug Alflutop in the treatment of periarticular lesions of a ‘mechanical’ nature.

Conclusions. Primary forms of periarticular disorders are a consequence of microtraumatization and can be attributed to ‘mechanical’ types of damage. The ultrasound is pivotal in the diagnosis and evaluation the severity of the lesion and its origin. Biomarkers of connective tissue damage can be detected in the blood of patients with periarticular disorders. The treatment results can be improved with drugs from the SYSADOA group.

Background. Patients with inflammatory bowel diseases (IBD) often have lesions of the musculoskeletal system, which is an extra-intestinal manifestation and mainly belongs to the group of seronegative spondyloarthritis (SPA). Ankylosing spondylitis (AS) is one of the main forms of diseases from the group of spondyloarthritis, associated with IBD. The frequency of AS in patients with IBD is of interest for elucidating the general pathophysiology of diseases. Colonoscopy is required to diagnose intestinal pathology. Colonoscopy in patients with AS to detect IBD, especially in the absence of intestinal symptoms, is very diffcult. Mainly for the diagnosis of IBD, the defnition of fecal calprotectin is used. Recently, there has been an interest in serum calprotectin, an increase in which is associated with a higher activity of the disease and is a marker of the intensity of inflammation in the intestine. However, there is currently no consensus on the clinical signifcance for serum calprotectin.

The aim. To evaluate the role of serum calprotectin in diagnosis of inflammatory bowel disease in patients with ankylosing spondylitis.

Materials and methods. In the analysis were included 50 patients with AS, fulflling the modifed New York criteria, among them were 36 (72%) men and 14 (28%) women, the mean age of patients was 42.5 ± 9.9, mean disease duration was 13.4 ± 8.7 years. All patients were examined with ESR, CRP, FC (range: 100–1800 µg/g), esophagogastroduodenoscopy, colonoscopy and quantitative analysis of the SC level using ELISA (Buhlmann MRP8/14 ELISA, range: 0.4–3.9 µg/ml).

Results. All patients had a high disease activity, mean BASDAI was 5.3 ± 1.8, mean ASDAS CRP was 3.7 ± 1.01, mean ASDAS ESR was 3.6 ± 1.01. 78% patients had high FC level (more than 100 µg/g), while only 18% patients had an increase of SC level. IBD were diagnosed in 11 cases: 6 (12%) patients with CD and 5 (10%) patients with UC, in the remaining cases (78%) was no intestinal pathology. Only two patients with IBD had a high SC level. SC level was more correlated with ESR (r = 0.5) and CRP (r = 0.5) (p < 0.05) levels, than with FC level (r = 0.4) (p < 0.05).

Conclusion. The results have shown that there was currently insuffcient data to assess the possibility of using SC in the diagnosis of IBD in patients with AS. There was a signifcant association between the SC, CRP and ESR, but not fecal calprotectin. Potentially SC may be more representative for systemic inflammation than intestinal inflammation.

Introduction. Osteoarthritis of the knee joints is the most common joint disease affecting more than 80% of people over 55 years of age. The priority method for the treatment of gonarthrosis is the use of local injection therapy with the introduction of synovial fluid endoprostheses based on hyaluronic acid, included in the Second Step of the ESCEO 2019 algorithm. Viscoelastic polyacrylamide gels for intra-articular administration since 2003 have also shown their high effciency in the symptomatic OA treatment. Since 2018, the new 3rd generation PAAG endoprosthesis of synovial fluid, Noltrexsin, has been actively used.

Objective. To compare the efficacy and safety of Noltrexsin viscoprosthesis use with oral NSAIDs in patients with grade I-III of gonarthrosis.

Materials and methods. 40 patients with gonarthrosis participated in a comparative study of the effcacy and safety of injection therapy Noltrexsin 4.0 ml No. 2 (study group, А) and oral administration of NSAIDs 200 mg per day (comparison group, В). NSAIDs were taken in groups A and B, the duration of therapy in both groups was 1 month. The results were evaluated by standard examination methods, including measuring the range of motion in the joint and scoring of physical signs, tests with walking up the stairs and at a distance, VAS, WOMAC, Lequesne Index.

Results. In group А, a more signifcant reduction in pain according to VAS was revealed to 15–20 mm at the grade I–II of gonarthrosis and up to 25–30 mm in the grade III, a decrease in the Lequesne index to 1–2 and 3–4 points, respectively. In group В with a standard therapy, and then on-demand within 6 months, a decrease in VAS was revealed on the 8–9th day, and after 6 months the level of pain at the grade I–II did not exceed 20–25 mm, at the grade 3 it did not decrease below 40–45 mm. The Lequesne Index decreased to 2 points at the grade I–II and to 6–7 points at the grade III. Changes of WOMAC index correlated with VAS.

Conclusions. 1. Noltrexsin can be used as a safe endoprosthesis of synovial fluid in the form of local injection therapy in patients with insufficient effect of chondroprotectors and NSAIDs. 2. Noltrexsin is recommended for use at all stages of arthrosis, as well as in comorbid patients.

The article reviews the clinical symptoms, main complications in patients with ANCA-associated systemic vasculitis (granulomatous with polyangiitis, microscopic polyangiitis, eosinophilic granulomatous with polyangiitis) and polyarteritis nodosa during the first three years of the disease. We evaluated the relationship between complications and long-term glucocorticosteroid therapy. Patients with granulomatosis had the most unfavourable course of the disease with a high risk of complications. A high incidence of ischemic strokes and chronic kidney disease in patients with microscopic polyangiitis has been identified. We also analyzed cases of lethal outcomes in patients with primary systemic vasculitis.

Introduction. The dynamics of changes in the concentration of polyglutamates of methotrexate (MTPG) over the past 20 years has been studied by several scientifc groups using various methods. For a number of reasons, the results of these studies cannot be called uniform and cannot be confdently projected onto the Russian population of patients with rheumatoid arthritis (RA). At the same time, therapeutic drug monitoring of methotrexate (MT) with clearly defned target values of metabolites could be an extremely useful tool in routine clinical practice.

Purpose of the study. To characterize the concentration of MTPG in dynamics during treatment and 12 weeks after discontinuation of MT.

Materials and methods. Two patients with early RA were traced 4, 12, 24 weeks after MT appointment, and also 12 weeks after its cancellation due to nausea that appeared during treatment. At each visit, an analysis was made for MTPG content by tandem gas chromatography-mass spectrometry.

Results. Against the background of treatment, the signifcantly predominant metabolite was MTPG with three and gour residues of glutamic acid (the so-called long-chain), while 12 weeks after discontinuation, MTPG 2 was the predominant fraction.

Conclusions. Low values of MTPG 3 and MTPG 4 with high values of MTPG 2 may indicate a recent initiation of treatment or MTB cancellation within the next 3 months. In the event of subjective adverse reactions (ADRs), it is advisable to consider the possibility of switching to a drug analogue of another manufacturer.

The detection in serum of monospecifc antibodies that induce a dense fne-speckled fluorescence when interacting with the DFS70 / LEDGF / p75 nuclear antigen is negatively associated with the development of systemic autoimmune rheumatic diseases (SARD) and increases the diagnostic specifcity of the screening study of antinuclear antibodies (ANA) using indirect immunofluorescence on HEp-2 cells (IIF-HEp-2). The results of assessing the clinical signifcance of anti-DFS70 antibodies vary depending on the test systems and the selection of patient groups. The aim of this work is to study the frequency of detection of monospecifc anti-DFS70 antibodies in blood serum in healthy individuals and patients with SARD. Sera of 74 healthy donors and 59 patients with SARD were studied (27 – systemic lupus erythematosus – SLE, 15 – Sjogren's syndrome – SjS, 17 – rheumatoid arthritis – RA). Classical antinuclear antibodies (ANA) and anti-DFS70 antibodies were determined by IIF using a mixture of standard and genetically engineered DFS70-KO HEp-2 cells that do not express DFS70 / LEDGF / p75 as a substrate. 14.9% of healthy donors and 83.1% of SARD patients (96.3% – SLE, 100.0% – SS, 47.1% – RA) were seropositive for antinuclear factor (ANF). Classical ANA with homogeneous, speckled, nucleolar, cytoplasmic, mixed types of fluorescence and the absence of anti-DFS70 antibodies were found in all ANF-positive patients with SARD and in 8.1% of healthy donors. Monospecifc anti-DFS70 antibodies without classical ANA were detected in 6.8% of healthy individuals and were absent in SARS. Among ANF-positive healthy donors, the frequency of isolated detection of anti-DFS70 antibodies was 45.5%. The detection of monospecifc anti-DFS70 antibodies can be considered as a potential predictive marker for excluding the diagnosis of SARD in ANF-positive patients with no or unclear clinical signs of these diseases.

Objective. To evaluate bone mineral density (BMD) indices in elderly and old age male patients with knee osteoarthritis (OA) depending on the state of the muscular system.

Subjects and methods. The trial enrolled 32 patients with knee OA. The mean age of the patients was 68.7 (66.1; 70.3) years. The diagnosis of knee OA was established according to the diagnostic criteria of the American College of Rheumatologists (ACR, 1991). For comparative analysis, all patients with knee OA were divided into 3 groups according to muscle condition (EWGSOP, 2010: muscle mass was assessed by multispiral computed tomography, muscle strength was measured using a wrist dynamometer, muscle function was examined using a battery of short tests): the 1st – 9 patients without sarcopenia, the 2nd – 11 patients with presarcopenia, and the 3rd – 12 patients with sarcopenia. BMD was assessed by dual-energy X-ray absorptiometry in the neck and proximal femur as a whole and in the lumbar spine.

Results. Osteopenic syndrome in the study cohort was diagnosed in 23 (71,9%) patients: osteopenia – in 19 (59,4%) patients, osteoporosis – in 4 (12,5%). Normal BMD values were observed in 9 (28.1%) patients. Osteopenic syndrome was detected in patients with sarcopenia signifcantly more often compared to patients without sarcopenia (p > 0.05) and with presarcopenia (p = 0.05). BMD indices in patients with sarcopenia in the neck and proximal femur in general were statistically signifcantly lower than in patients without sarcopenia and with presarcopenia (p < 0.05). There was a direct correlation between total skeletal muscle area at the LIII level and densitometric indices of the femoral neck.

Conclusions. Sarcopenia is associated with low BMD indices in the neck and proximal femur in general in elderly and senile male patients with knee OA

Introduction. Rheumatoid arthritis (RA), as a steadily progressive disease leading to joint destruction and functional instability of the knee joints, often requires orthopedic correction.

The aim. Of the review was to analyze the surgery strategy and technical features of knee arthroplasty and replacement in patients with RA.

Basic provisions. RA is characterized by a number of abnormalities not only due to erosive arthritis and active persistent synovitis, but also caused by a decrease in bone mineral density, damage to the periarticular structures and patella, the formation of bone defects, as well as a high risk of postoperative complications. All these factors should be taken into account while choosing relevant surgical treatment and knee replacement technique. The article presents the optimal approaches for performing knee replacement in RA patients, taking into account the peculiarities of the existing structural and functional disorders.

Conclusion. TEC in patients with RA requires a personalized approach based on evaluation of disease-associated risk factors affecting the results of orthopedic correction and the likelihood of complications.

Introduction. Ankylosing spondylitis and Crohn's disease are chronic recurrent autoimmune diseases. In case of a combined course their activity tends to progress, regardless of the phase of the underlying disease.

The aim of the study. To analyze the combination of ankylosing spondylitis and Crohn's disease, issues of its diagnosis and selection of therapy.

Results. The combination of ankylosing spondylitis and Crohn's disease tend to progress independently, regardless of the phase of the underlying disease. The main problem that complicates diagnosis is the lack of a unifed approach to the defnition of extra skeletal and extraintestinal manifestations.

Conclusion. The management of patients with a combination of ankylosing spondylitis and Crohn's disease is a common problem of rheumatologists and gastroenterologists. An interdisciplinary approach will allow timely diagnosis of extra-skeletal and extra-intestinal manifestations and correct therapy.

The literature review presents data on the role of pathological angiogenesis in the development of psoriasis. Several recent studies have shown, in addition to cytokine imbalance and activation of the T-cell link of immunity, an important pathogenetic link is pathological vascularization. Vascular changes in the dermis appear before clinically visible skin manifestations and can persist for a long time after treatment, as well as the phenomena of neoangigenesis in the synovial membrane and enthesises contribute to the chronicization of inflammatory process in psoriatic arthritis. The article presents an overview of the modern literature on the main regulator of angiogenesis – vascular endothelial growth factor, its role in the pathogenesis of psoriasis and possible therapeutic prospects.

The article presents a review of studies that have examined osteoporosis in rheumatic diseases, including rheumatoid arthritis, spondylarthritis, psoriatic arthritis, systemic connective tissue diseases, and systemic vasculitis. The review discusses the pathogenesis, diagnosis and treatment of osteoporosis in these diseases, presents the results of epidemiological studies assessing the risk factors and the prevalence of osteoporosis in rheumatic diseases. There was a high prevalence of osteoporosis and fractures in rheumatic diseases, exceeding the population, associated primarily with systemic and local inflammation, as well as with the intake of glucocorticoids. It is indicated that the existing strategies for the treatment of rheumatic diseases may partially reduce bone loss, but long-term administration of glucocorticoids, on the contrary, increase bone resorption. The review presents data on the medications for the treatment of osteoporosis and approaches to the treatment of glucocorticoid osteoporosis.