Aim. To evaluate the effect of COVID-19 on the clinical course of immunoinflammatory rheumatic diseases (IRD).

Material and methods. The clinical course of IRD was analyzed in 324 patients who underwent new coronavirus infection (NCI) from March 2020 to February 2021 and were treated at Clinical Rheumatology Hospital No. 25 (Saint-Petersburg, Russia) for exacerbation of the underlying disease.

Results. The risk factors of severe COVID-19 course in IRD were: age older than 60 years, presence of comorbid conditions (IHD, CHD, COLD), use of glucocorticoids in dose more than 12.5 mg per day and erythrocyte sedimentation rate values ≥ 40 mm/h before development of NCI. The use of immunosuppressive therapy and biological therapy had no effect on the worsening of the course of the viral infection in patients with IRD. The development of post-covid syndrome (asthenia, dyspnea, weight loss, memory loss) was noted in ¼ of the patients. Post-covid articular syndrome was characterized by the formation of arthritis associated with viral infection in 3.6% of patients, transformation of undifferentiated arthritis (UDA) into specific nosological forms in 49.0% (more often into early rheumatoid arthritis, RA), and exacerbation of joint syndrome in 83.4% of patients with advanced stage RA. In patients with diffuse connective tissue disease (DCTD), a significant increase in immunological activity due to antinuclear antibodies (maximum 1: 163840) was noted. We present clinical cases of arthritis associated with viral infection and fatal outcome in a patient with systemic sclerosis and interstitial lung damage after COVID-19.

Conclusions. In the cohort of patients with IRD observed at Clinical Rheumatology Hospital No. 25 (Saint-Petersburg, Russia) COVID-19 had a moderate to severe course in half of patients, initiated the development of pneumonic complications in 68.6% of patients, arthritis associated with viral infection in 3.6%, transformation of UDA into IRD in 49.0% of cases and exacerbation of the main disease in the great majority of patients. Patients with DCTD with interstitial lung damage have a high risk of adverse outcome of NCI, especially in cases of unstable course of the disease, pronounced immunosuppression and require special monitoring.

The authors present their own clinical experience with the use of Alflutop in a comorbid patient with osteoarthritis and increased pain after undergoing CCI, which indicates its effectiveness and cardiovascular safety. An important practical advantage of Alflutop should be considered the absence of its effect on the parameters of hemocoagulation and the reduction in the need for NSAIDs, which reduces the risk of thrombotic complications characteristic of long-term COVID. A short course of Alflutop (ten intramuscular injections of 2.0 ml every other day) contributes to ease of use and increased adherence to therapy in patients with osteoarthritis.

The article presents an analysis of the current view of comorbidity problem in rheumatology from the perspective of inflammatory disorders of the joints and spine combination with the most common diseases of the internal organs and endocrine system. The data gained from recent sources regarding the frequency and structure of concomitant disorders in patients with rheumatoid arthritis (RA) and spondylarthritis (ankylosing spondylitis [AS] and psoriatic arthritis [PsA]) are presented. It has been shown that the most common comorbidity in patients with RA, AS, PsA are diseases of the gastrointestinal tract and cardiovascular diseases. The authors present the results of their own research on the study of comorbidity in RA, AS and PsA, which are consistent with modern literature data. It is noted that there are specific disease-associated factors, as well as the negative effect of anti-inflammatory drugs in the development and manifestation of comorbid pathology.

Numerous studies have shown that the trabecular bone score (TBS) in patients with rheumatic diseases and especially in persons receiving glucocorticoids predicts fractures better than the bone mineral density (BMD) of the spine or the value of a 10-year probability of osteoporotic fracture according to the FRAX calculator. This article describes the role of TBS in determining the indications for prescribing anti-osteoporotic treatment on the example of a clinical case of a postmenopausal woman with a confirmed diagnosis of rheumatoid arthritis and a slight decrease in BMD.

Gout is one of the most common rheumatic diseases, the peculiarity of which is the development in conditions of prolonged hyperuricemia (HU). The rapid increase in the incidence of gout with a slight increase in the prevalence of HU actualizes the issue of diagnosing gout at the preclinical stage.

Objective. To determine the frequency of ultrasound signs of urate crystal deposition in patients with asymptomatic HU (AHU) and gout.

Results. 112 patients with AHU and gout were included, the mean age in both groups was 49.7 years. Ultrasound signs of deposition of sodium monourate crystals (SMC) among patients with AHU were determined in 21.1% of the patient by ultrasound of the knee joints and 17.5% of patients by ultrasound of the feet. Patients with gout showed the same US features in 38.1% and 56.3% of cases, respectively. There is a strong correlation between the detection of SMC by ultrasound and a history of arthritis attack of the respective joints.

Conclusions. The detection of SMC and concomitant HU is very common among patients with AHU, which can be considered the preclinical stage of gout.

The objective of the discussion is clinical and instrumental specifics of the atlantoaxial region in rheumatic diseases. Pathological changes of the cervical spice are not uncommon in rheumatic diseases. Area of atlantoaxial articulation attracts particular attention, which is discussed rarely by rheumatologists. This review discusses the magnetic resonance imaging (MRI) specific pattern of the atlantoaxial region pathology in rheumatic diseases. The pathogenesis, clinical picture and the craniometric criteria pathology are the areas of concern.

Conclusions. The atlantoaxial region is a complicated anatomical structure. Pathological processes that occur in this area due to rheumatic diseases can manifest severe neurological symptoms. MRI makes it possible to recognize many structural disorders at an early stage. As a result, images of craniometric measurements on MRI allow to timely detect deviations that subsequently lead to serious complications, which could be corrected and prevented.

The article presents literature data on the incidence and risk factors of osteoporosis in ankylosing spondylitis (Bekhterev's disease), the features of the course of the underlying disease in their combination. Separately, the issues of the relationship of inflammation, calcium metabolism, kidney stone formation and osteoporosis are considered. The directions of further research for predicting the development and prevention of osteoporosis in patients with ankylosing spondylitis are determined. This review expands doctors' understanding of comorbidity in inflammatory diseases of the joints and spine, in particular, in ankylosing spondylitis.

Introduction. Rehabilitation of patients with rheumatoid arthritis and polyarthritis after arthroplasty is a debatable and open issue. The main direction in their rehabilitation is physical therapy, and the safest and most convenient way is aqua gymnastics.

The aim. To analyze the clinical and functional results in patients with rheumatoid arthritis after a course of hydrokinesiotherapy after total hip arthroplasty. Materials and methods. Twenty patients after total hip arthroplasty used the bipedal cyclic swimming method (Patent of Russia No. 2733686) to supplement the standard rehabilitation complex. The course consisted of 7–10 lessons and was carried out 1.5 months after the operation. The evaluation criteria were pain syndrome according to the visual analog scale, goniometry, DAS28 (Disease Activity Score in 28 joints), Harris scale and short-HAQ (short Health Assessment Questionnaire).

Results. Eighteen patients remained in the study. They said that active water activities reduced the pain syndrome. In terms of angle measurements, we saw an improvement in flexion and extension in the joint. The study shows that arthroplasty with synovectomy helps to reduce the activity of the disease, and the use of aqua gymnastics in half of the cases supports this trend. All patients improved on the Harris and HAQ scores, but the best scores were in patients who were in remission or had low disease activity before surgery.

Conclusions. The presented method of swimming can improve postoperative results. This study is a pilot one and requires further study using a control comparison group.

The human body is densely populated by commensal and symbiotic microorganisms whose genome and ecosystems constitute the microbiome whose presence regulates the development and function of the human immune system. In addition, commensal microorganisms influence other physiological processes of the host metabolism. Recently, many scientists have emphasized the importance of the microbiome in the pathogenesis of several diseases, including autoimmune diseases. Dysbiosis can adversely affect the immune system both locally and systemically, thereby predisposing to certain pathologies, including rheumatoid arthritis (RA); in which the microbiome already in its early stages differs from that of healthy individuals. The purpose of this review is to examine the studies linking microbiome changes with autoimmune mechanisms involved in the pathogenesis of RA and to consider possible methods of their correction.

Backgrounds. Osteoarthritis (OA) occupies the first rank among diseases of the musculoskeletal system and accounts for 18.4% of the structure of this pathology. Currently, OA is considered as a disease in which there is a violation of the processes of remodeling (degradation and synthesis) of cartilage tissues, subchondral bone, joint capsule, tendon-ligamentous and muscular apparatus. An increased concentration of cartilage glycoprotein-39 (CGP-39) in the circulation is associated with inflammatory diseases and the processes of active tissue restructuring. To date, CGP-39 is a marker of chondrocyte activation and a sign of progressive OA, which determines its clinical significance. Along with this, the role of this biomarker in evaluating the effectiveness of anti-inflammatory therapy is relevant.

The purpose. Comparative assessment of the quantitative content of CGP-39 in patients with knee joint OA, depending on the severity of inflammatory changes in the joints, the dynamics of the disease and the effectiveness of therapy.

Methods. The study included 36 patients with OA and 30 practically healthy volunteers, identical in gender and age to the examined patients. The mean age of patients was 64 years, the average duration of the disease was 6 years. The diagnosis was determined according to the diagnostic criteria of the American College of Rheumatology (ACR, 1991). Along with the generally accepted clinical, laboratory and instrumental diagnosis of OA, in all patients and in control persons the levels of circulating CGP-39 were measured by enzyme immunoassay (ELISA). All examined patients received Ambene® Bio for 20 days, followed by repeated determination of the level of CGP-39. For statistical processing of the obtained data, we have used the programs Microsoft Excel 2007 and Statistica 10.0. Using the application program KRelRisk 1.1, the relative risk indicator for the studied factor was determined.

Results. In the blood of patients with OA, a significant increase in the levels of CGP-39 has been found in comparison with the group of healthy individuals, which indicates increased degradation of articular cartilage in OA. As the severity of knee OA increased, the concentration of CGP-39 in the blood serum significantly raised, including in comparison with the control group. Reliable direct correlations were found between CGP-39 and clinical indices of knee OA severity. The content of CGP-39 in serum in patients with stage III radiological OA was significantly higher than in patients with stage I–II. The highest level of CGP-39 in patients with OA is associated with the presence of synovitis. TThe level of CGP-39 significantly decreased in patients with knee OA after a course of Ambene® Bio therapy, which confirms the participation of CGP-39 in inflammation on the one hand and the possibility of its use as an indicator of the effectiveness of anti-inflammatory therapy on the other hand.

Conclusions. CGP-39 as a marker of inflammation and degradation of articular cartilage reflects the severity of the course of OA. The investigation of this biomarker is useful not only for diagnostic purposes, but also to assess the response to anti-inflammatory treatment in patients with knee OA.

Chronic inflammatory rheumatic diseases are associated with an increased risk of cardiovascular disease. In this group of patients, inflammation causes various changes in lipid metabolism, which in a chronic course may contribute to an increased risk of atherosclerosis. The most frequent abnormality is decreased serum high-density lipoprotein cholesterol (HDL–C) and increased triglyceride (TG) levels. This imbalance may be due to increased production and secretion of very low-density lipoprotein cholesterol (VLDL–С) in the liver and decreased clearance of TG-rich lipoproteins. The mechanisms by which inflammation lowers HDL–C levels are still unclear. Additionally, there is a persistent increase in lipoprotein (a) (Lp[a]) due to its increased synthesis. Thus, systemic inflammation negatively affects lipoprotein function: LDL–C oxidation becomes more active since there is the decreased ability of HDL–C to prevent this pathway. Moreover, chronic inflammation adversely affects the reverse cholesterol transport mechanism. The greater the severity of the underlying disease is associated with the more pronounced disorders in lipid metabolism. In general, approaches to the correction of lipid metabolism in patients with inflammatory rheumatic diseases are similar to those in patients from the general population.