Specialists in rheumatology quite often have to deal with the so-called overlap syndromes, characterized by the phenomenon when the onset of the immune-inflammatory process corresponding to one rheumatic disease later turns to another clinical form or even process. It is well known about the possible transformation of rheumatoid arthritis (RA) into systemic scleroderma, Sjögren's disease, systemic lupus erythematosus (SLE). Along with this, of particular interest is the likelihood of developing an autoimmune process in the setting an autoinflammatory syndrome, which includes adult Still's disease (ASD). The article presents a clinical observation demonstrating the transformation of APS into spondyloarthritis, and then into RA. While there are many reports of the transition from systemic juvenile idiopathic arthritis (sJIA) to seropositive RA, the development of seropositive RA in adults with autoinflammatory syndrome is a very rare clinical situation. The analyzed aspect is of particular importance since the approaches to the management of patients with ASD and RA differ significantly in the range of biological agents used in these diseases. So, if the use of IL-1 inhibitors is recommended for the treatment of APS, then with a confirmed diagnosis of RA, the prospect of using other anticytokine agents, preferably IL-6 inhibitors, opens up. Thus, the observed clinical case is interesting not only from the standpoint of the importance of the precise form of the immune mediated disease identification at the time of choosing the optimal treatment, but also the differentiated use of biological agents, including Russian-made IL-6 inhibitors.

Gout and calcium pyrophosphate crystal deposition disease (CPPD) are the most common inflammatory rheumatic diseases. It is known that the clinical manifestations of both diseases can simulate each other, in addition, cases of a combination of gout and CPPD are not uncommon, which complicates the diagnosis and selection of therapy. We present a case report of the successful use of the interleukin-1 beta (IL-1β) receptor antagonist Anakinra in a patient with a combination of gout and CPPD with chronic arthritis resistant to previous therapy with colchicine, non-steroidal anti-inflammatory drugs and glucocorticoids.

To date, the main resonance is caused by studies of the so-called post-COVID syndrome, which can occur even in patients who have had mild or moderate COVID-19. The present review provides a historical background on the origin of this term, considers the most common rheumatological manifestations of post-COVID syndrome, including arthralgia, rash, perniosis, dyspnea, fatigue, fibromyalgia, the formation of autoantibodies and markers of systemic inflammation. The review also provides current views on the treatment of post-COVID syndrome. The authors emphasize the need for differential diagnosis between rheumatological manifestations of post-COVID syndrome and the onset of rheumatic disease after COVID-19, and substantiate a multidisciplinary approach to therapy methods.

Aim. To evaluate the association of nesfatin-1 (NF-1) levels and bone remodeling markers in patients with rheumatoid arthritis (RA).

Materials and methods. 110 patients (105 women and 5 men) with RA, classified by ACR/EULAR 2010 criteria were enrolled in our study. All patients undergone complete clinical and laboratory examination. NF-1 serum levels were determined using a commercial test-systems (RayBio® Nesfatin Enzyme Immunoassay [EIA] Kit). Statistical analysis was performed using a software package Statistica 12.0. The results were considered statistically significant at p < 0.050.

Results. Significant positive correlation was determined between serum NF-1 levels and Intact N-Terminal Propeptide of Type 1 Procollagen (P1NP) levels (r = 0.218; p = 0.022). Serum NF-1 levels were not associated with bone mineral density in lumbar spine and femur. Serum NF-1 levels didn't correlate with body composition indices and Beta-CrossLaps levels. Patients with osteoporosis (n = 53) and osteoporotic fractures (n = 25) had statistically significant higher levels of NF-1 (Z = –2.060; p = 0.040 и Z = –2.370; p = 0.017 respectively). However, serum NF-1 levels didn’t correlate with cumulative dose of glucocorticoids (ρ = 0.090; p = 0.368) and the duration of glucocorticoids intake (ρ = 0.070; p = 0.462).

Conclusions. In our study, we determined the significant positive correlation between NF-1 and P1NP levels, supposingly due to NF-1 possible effect on the osteoblasts differentiation and function. Patients with osteoporosis and osteoporotic fractures had higher median blood serum levels of NF-1.

Aim. To evaluate the nutritional status and its relationship with osteoporotic phenotype of body composition in women with rheumatoid arthritis (RA).

Material and methods. The study included 91 women aged 40 to 75 years with RA according to ACR/EULAR criteria (2010). A questionnaire, laboratory examination and dual X-ray absorptiometry of whole body, lumbar spine and proximal femur were conducted. Nutritional status was assessed using a MNA (Mini Nutricial Assessment) questionnaire.

Results. Risk of malnutrition and malnutrition according to the MNA were detected in 42.9 % and 1.1 % of patients with RA, respectively. These patients differed from those with normal nutritional status with a higher risk of osteoporotic hip fracture according to FRAX (p = 0.035), lower appendicular muscle mass (AMM) (p = 0.048) and lower QOL according to VAS (p = 0.012). A positive correlation was established between the nutritional status by MNA and BMI (r = 0.280; p = 0.007), as well as total muscle mass (r = 0.280; p = 0.008), AMM (r = 0.320; p = 0.002) and AMM index (r = 0.280; p = 0.009). In multivariate logistic regression analysis, age above 55 years (OR = 7.76; 95 % CI: 2.17–27.69), nutritional status by MNA (OR = 0.68; 95 % CI: 0.51–0.92) and AMM index less than 6 kg/m² (OR = 3.43; 95 % CI: 1.16–10.21) were independent factors associated with osteoporotic phenotype in RA patients.

Conclusion. Malnutrition occurred in 44.0 % of RA patients. Women at risk of malnutrition had a higher 10-year probability of hip fracture according to FRAX. Age and AMM index were positively associated, while nutrition status according to MNA was negatively associated with osteoporotic phenotype of body composition.

The clinical picture of the ankylosing spondylitis (AS) is quite diverse. Extra-articular manifestations such as eye involvement (uveitis), damage of the aorta (aortitis), aortic valve insufficiency, inflammatory bowel disease, IgA nephropathy are often observed alongside with the damage of the musculoskeletal system. Since the course of AS is characterized by the significant variability the therapy of the patient requires an individualized strategy, depending on the predominant clinical manifestation. In this article we have considered development of the clinical features and disease progression in patient with AS as well as have analyzed and discussed the difficulties in AS pts treatment. Optimal treatment in case of the primary resistance to conventional drugs and the following failure of two drugs belonging to the biological agents is of a special interest in this case.

This article gives a review of the regulation by the Russian law of the so-called ‘off-label’ use of medicinal drugs, that is the use of drugs outside their approved indication, information in data sheets and other known properties. The definition of the term ‘off-label’ is presented in details for which the understanding of the term in different countries is summarized. The discussion covers both off-label prescription and marketing practices. The article emphasizes the connection between the legal aspects of the off-label use and the model of national law regulation for providing legal services in general. The text culminates at an introduction of the new Russian legislative amendments granting more opportunities for off-label drug prescription.