Alfacalcidol has shown its efficacy and safety in the treatment of patients with osteoporosis (OP) during various clinical studies. The article presents data from a study conducted in real clinical practice in order to assess the relevance of alfacalcidol in the treatment of OP patients and the patients' adherence to treatment. A survey of doctors and patients with OP and low-energy fractures was conducted. Alfacalcidol was prescribed by doctors in 27 % of cases, while in 19 % – in combination with antiresorptive drugs. Among the interviewed patients with the average duration of OP 3 years, 25 % of the respondents took alfacalcidol. Adherence to treatment during the last year was 38 %. Follow-up of patients after a low-energy fracture showed that 31 % of them received alfacalcidol, among whom treatment adherence for 36 months was 50 % for monotherapy, and 21 % for combination therapy. Thus, the survey showed that in real clinical practice, alfacalcidol is widely used both in the management of patients with OP and after low-energy fractures.

The complexity of timely diagnosis of giant cell arteritis (GCA), as the most common form of systemic vasculitis in the elderly, is due to the nonspecificity of clinical manifestations and the absence of specific immunological markers. New difficulties arise during the period of coronavirus infection, which manifests itself in similar syndromes and at the same time can provoke immuno-inflammatory rheumatic disease. In this regard, it is extremely important to make a correct differential diagnosis between persistent viral infection and the development of systemic vasculitis. This article presents a clinical observation demonstrating the complex process of diagnosis and differential diagnosis of GCA in the conditions of the COVID-19 pandemic. The patient was hospitalized due to a confirmed coronavirus infection. However, despite the standard therapy and the achieved eradication of the coronavirus, the symptoms characteristic of GCA and polymyalgia rheumatica (PR) persisted. A precision analysis of the clinical picture allowed us to establish that the typical manifestations of GCA and PR occurred in the period preceding COVID-19 infection. Subsequent in-depth examination made it possible to verify the diagnosis of GCA and PR based on the current classification criteria. The therapy with glucocorticoid and methotrexate made it possible to achieve remission. The presented observation will help to raise awareness of general practitioners and related specialties about the need to rule out GCA and PR in the case of prolonged unexplained fever, myalgia, headache, joint pain and swelling, transient visual disturbances, jaw claudication in elderly patients in the setting or after coronavirus infection.

Infection caused by hepatitis B virus (HBV) is one of the most common hemocontact infections. The special life cycle of the hepatitis B virus, the course of infection, often hidden, and the high risk of developing life-threatening conditions, such as fulminant hepatitis and hepatocellular carcinoma, make it necessary to exercise special caution when choosing therapeutic tactics for rheumatological patients, since the vast majority of drugs used in rheumatological practice have immunosuppressive properties. This review updates information on the risks of reactivation of HBV infection in the treatment of currently used antirheumatic drugs, considers difficult to curate variants of chronic hepatitis B with delta agent and extrahepatic manifestations, in particular, thrombocytopenia. The most systematic and consistent approach to ranking the risk of reactivation of HBV infection (low [less than 1 %], moderate [1–10 %] and high [higher than 10 %]), in accordance with the serological status of the patient, as well as the type and duration of immunosuppressive treatment used, is proposed by the American Gastroenterological Association. The authors have attempted to unify the current literature data according to this classification.

Objective. To study the effect of various basic and genetic engineering biological therapies (infliximab, rituximab, tocilizumab) used as first, second- and third-line drugs in combination with methotrexate on clinical course, quality of life (QOL), and the evolution of articular erosions and synovitis in patients with rheumatoid arthritis (RA) during 12 months of follow-up.

Material and methods. This paper is an open observational study of the efficacy and safety of various basic and genetic engineering biological therapy agents (bDMARD) in patients with early active RA who are in the Mechnikov North-West State Medical University registry. Included are 151 patients with early RA (eRA), the average age is 58.2 ± 5.5 years, the disease duration is 6.5 ± 0.3 months, DAS 28-CRP – 4.48 ± 0.87. At the first stage, basic therapy was administered to patients with eRA by random sampling: sulfasalazine (CC) 2 g per day (group I – 55 patients), methotrexate (MT) – 20 mg per week (group II – 55 patients), or leflunomide (LF) 20 mg per day (group III – 41 patients). The follow-up was 12 months. At the second stage, 101 patients with persisting moderate (DAS 28: 3.2–5.1) and high levels of RA activity (DAS 28 > 5.1) despite ongoing therapy with DMARDs were assigned MT at a dose of 25 mg per week (subgroup 1–25 patients), or MT – 20 mg per week in combination with infliximab (INF) – 3 mg/kg (subgroup of 2–25 patients), or – MT 20 mg per week and rituximab (RM) – two infusions of 1000 mg at the week 0 and 2 and then at the week 52nd and 54th with a duration of observation of 12 months. In the third stage, 20 patients (16 women and 4 men aged 28 to 67 years) with a high disease activity DAS 28-CRP despite previous therapy with MT and INF or RM were transferred to therapy with an IL6 – tocilizumab receptor blocker as a second-line or third-line drug. The duration of observation ranged from 6 months to five years.

Results. By 12 months of treating DMARDs, clinical remission was achieved more often in the MT group than in the LF group (43.2 and 32.4 %) (p < 0.05), and was accompanied by a decrease in the expression of markers of early activation of T-lymphocytes, IL-1β, IL-2 and IL-4. In the SS group, clinical remission was not observed, while there was a significant increase in the median of the total Sharpe score and erosion score relative to the baseline. The prescription of INF or PM as the first bDMARD after 12 months led to a significant increase in the physical and psychological components of the patients' QL and positive dynamics of the HAQ index compared to baseline values. The use of tocilizumab as a second-line and third-line drug in patients with active RA and the ineffectiveness of previous therapy for DMARD and bDMARD contributed to a significant decrease in DAS 28-CRP by as early as 24 weeks of follow-up. Cases of serious adverse reactions (AE) are not marked.

Conclusions. There were no statistically significant differences in the dynamics of CRP, ESR, circulating immune complex and X-ray progression indicators between the groups of patients who received biological therapy of INF and RM, which confirms the possibility of ‘switching’ therapy from the first bDMARD to the drugs of subsequent lines with an increase in the clinical activity of RA. Tocilizumab can be a second- and third-line drug with an ‘escape’ effect from other bDMARDs.

Background. Antinuclear antibodies (ANA) are a group of antibodies that target nuclear and cytoplasmic antigens. Testing for ANA using an immunofluorescence assay (IFA) on HЕp-2 cell (IFA-HEp-2) is a screening test for the diagnosis of systemic autoimmune rheumatic diseases, druginduced lupus erythematosus, autoimmune liver diseases, juvenile idiopathic arthritis. In routine ANA testing final report forms bears important, but unstandardized variables (e. g., screening and final titers of ANA, coding of glow types, the procedure for performing confirmatory tests). Aim of the study. Develop a standard report form for IFA-HEp-2 testing results.

Material and methods. Survey of 10 immunological and clinical diagnostic laboratories using the ICAP questionnaire adapted by the Working Group on Standardization of the definition of ANA by the IFA-HEp-2 method (Committee on Immunology of the Association ‘Federation of Laboratory Medicine’).

Results. According to the results of a survey: most of the participants use a screening dilution of serum 1:160; indicates the maximum end titer of antinuclear factor (ANF), cytoplasmic staining; identifies staining types (including AC encoding); considers it mandatory to make confirmatory tests to detect ANA to individual nuclear antigens in ANF-positive patients, but does not provide a list of this tests in the results form; describes ANF titer for each of the detected glows separately; designates ANF titers using a colon and does not give a clinical interpretation of the results. Based on interlaboratory consensus, ICAP recommendations and the requirements of ISO 15189, the standard report form for IFA-HEp-2 testing results was developed.

Conclusions. To achieve high quality of interaction between clinical diagnostic/immunological laboratories and clinical departments of health care facilities, it’s necessary to introduce into practice a standard form for IFA-HEp-2 testing results, developed relying on modern clinical recommendations and interlaboratory consensus.

Introduction. Osteoarthritis (OA) in the Russian Federation is still not included in the list of socially significant diseases, despite the fact that this pathology limits the level of physical activity of the population more than diseases of the cardiovascular system, visual impairment and diabetes. European experts emphasize the relevance of research to develop methods to improve the effectiveness of viscosupplementary therapy in OA. The purpose of the study. To evaluate the efficacy, safety and long-term results of treatment of gonarthrosis with sodium hyaluronate.

Materials and methods. The study included 180 patients with gonarthrosis with insufficient efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) on demand and oral symptomatic slow-acting drugs against osteoarthritis (SYSADOA). The patients were randomized into three groups. Group 1: 50 patients who received sodium hyaluronate (Ripart®; Ingal, Russia) intra-articularly. Group 2: 30 patients received intra-articular SYSADOA (bioactive concentrate of small marine fish). The control group consisted of 100 patients who received drugs of the SYSADOA group intramuscularly.

Results. An effective reduction in pain both at rest and during movement was achieved in most patients of all groups, but the treatment groups differed statistically significantly in the speed of achieving the clinical effect and its duration. In the 1st group, a significant decrease in the VAS pain index was observed already at the 1st week and by the 3rd month it was –49.1 % (p < 0.001). In the comparison and control groups, the indicators of speed, the degree of pain reduction, and the duration of the effect of therapy were also significant (p ≤ 0.050). But the effectiveness of therapy in these groups was statistically significantly lower than in patients of group 1 (p ≥ 0.050). It should be emphasized that the intra-articular administration of sodium hyaluronate provided a significant reduction in the need for patients to additionally take NSAIDs. After 3 months of therapy, only 5 patients (10 %) of this group continued to take NSAIDs (p < 0.001); 20 – completely stopped taking NSAIDs (40 %) and 25 (50 %) reduced the dose of NSAIDs taken, the duration of the effect lasted up to 12 months.

Conclusions. In our study, sodium hyaluronate demonstrated high efficiency in reducing pain in patients with gonarthrosis and contributed to a significant decrease in the need for patients to take NSAIDs for 12 months.

The article reports the problems of sacroiliitis and spondylitis in patients with ankylosing spondylitis and psoriatic arthritis. Based on the concept of primary involvement the sacroiliac joint in inflammation, they are most often is the object of investigations. But inflammatory changes also affect the spine that’s called the spondylitis. Due to the widespread introduction of medical imaging, scientists know the various variants of axial characteristic in inflammatory spondylopathies: angular (Romanus lesion) and non-angular spondylitis (Andersson lesion, osteitis of the arch, inflammation of the facet joints). However, generally accepted criteria for assessing inflammation of the spinal column in these pathologies have not been developed. Also, frequency of these lesions is not researched. Further study of various variants of spondylitis in ankylosing spondylitis and psoriatic arthritis is necessary, since these data will significantly contribute to the understanding of axial involvement in inflammatory spondylopathies.

Purpose of the study. To study the frequency and structure of postcovid syndrome (PCS) in patients with rheumatic diseases (RD).

Materials and methods. The study included 70 patients with RD who had a coronavirus infection during the year. A questionnaire was carried out on the severity of the coronavirus infection, persisting symptoms in the postcovid period. Questionnaires of anxiety and depression, sleep quality were used, the activity of RD was assessed.

Results. Manifestations of PCS occurred in 50 (71 %) patients, of which 47 (67 %) had 2 or more manifestations. PCS was observed equally often in patients with different severity of infection. Such the symptoms of PCS as weakness, arthralgia, increased blood pressure, shortness of breath, tachycardia prevailed during 3 months after COVID-19. Half of the patients had a decrease in the severity of weakness, arthralgia and shortness of breath after 6 months, but the destabilization of blood pressure and tachycardia remained at the same level. Such the psychoemotional manifestations of PCS as moderate depression, memory impairment, insomnia were observed.

Conclusions. More than 2/3 of patients with RS who have undergone COVID-19 are faced with PKS. In 1/3 of the examined patients with RD the duration of the persistence of symptoms of PCS exceeds 6 months after infection. After revealing of blood pressure destabilization in patients with rheumatic diseases, it is advisable to assess cardiovascular risks in patients who have undergone COVID-19.

Methotrexate is widely used for treatment rheumatic diseases, including psoriatic arthritis. Adverse reactions could develop during methotrexate therapy, the most common of which are skin lesions, liver dysfunction, diarrhea, nausea, etc. Gynecomastia is a rare complication of low-dose methotrexate therapy. The mechanism of its development is not fully understood. We present a case report of the development of gynecomastia in a patient with psoriatic arthritis during treatment with methotrexate.

A clinical case of recurrent polychondritis with damage to the cardiovascular system in the form of the development of acute coronary syndrome is presented. Recurrent polychondritis is a rare systemic presumably autoimmune disease that is affecting cartilage tissue. The main cause of high mortality in patients with systemic diseases is the early formation and accelerated progression of atherosclerotic vascular lesions that cause the development of myocardial infarction, stroke, chronic heart failure and sudden death. Recurrent polychondritis is characterized by clinical polymorphism. The diagnosis of the disease requires the interdisciplinary medical participation of at least five specialists.