The article is devoted to the analysis of the current state of the problem of the most common autoinflammatory disease – familial Mediterranean fever (FMF). The authors provide data on the prevalence of FMF, the genetic mechanisms of its development, the influence of MEFV gene mutations on the manifestation of FMF and its clinical phenotypes. The polymorphism of the mutated MEFV gene in various ethnic populations is discussed. Particular attention is paid to the combination of FMF with other rheumatic processes, primarily with spondyloarthritis. It has been shown that immunoinflammatory comorbidity is characteristic of the early onset of FMF, a more severe course of this disease, and is determined by the specific genotype of the patient. In this regard, the importance of genetic analysis is emphasized not only for the timely verification of FMF, but also for determining the prognosis in terms of the risk of developing spondyloarthritis and amyloidosis. An analysis of works on the pharmacotherapy of FMF showed that although colchicine remains the first-line drug, interleukin-1 inhibitors are actively used in the treatment of patients with FMF. The results of multicenter studies demonstrate the high efficacy and safety of the intelekin-1 inhibitor canakinumab in the treatment of FMF and other autoinflammatory diseases in children and adults. In this regard, with the development of colchicine resistance or poor tolerability of colchicine, interleukin-1 inhibitors are considered as the optimal therapeutic option.

Pneumococcus plays a primary role as a causative agent of pneumonia both in the general population and in patients with immuno-inflammatory rheumatic diseases (IVRS), including spondylarthritis (SpA). However, data on the immunogenicity, efficacy and safety of pneumococcal vaccines in patients with SpA are limited.

The aim of the study. To study the immunogenicity, efficacy and safety of the 23-valent pneumococcal polysaccharide vaccine (PPV-23) in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA), observed at the V.A. Nasonova Research Institute (Moscow, Russia).

Materials and methods. 145 people were included in the study: 51 patients with AS, 25 with PsA, 69 in control group (СG) without IVR. The majority of patients (65.8%) received immunosuppressive therapy. PPV-23 was administered in an amount of one dose (0.5 ml) subcutaneously against the background of antirheumatic therapy, regardless of the activity of the main IVR. The level of antibodies (AT) to pneumococcal capsular polysaccharide was determined using the EIA PCP IgG kit (TestLine Clinical Diagnostics, Czech Republic) before vaccination and 1, 3 and 12 months after it. The clinical efficacy and safety of PPV-23 were also evaluated, including the effect on the activity of AS and PsA according to the dynamics of BASDAI and DAPSA indices.

Results. After 1, 3 and 12 months after vaccination, the concentration of pneumococcal AT was significantly higher compared to baseline values, which indicates sufficient immunogenicity of PPV-23. The clinical efficacy of PPV-23 in patients with AS and PsA was 98.7%. In general, there was no negative effect of vaccination on the activity of the underlying disease. The frequency of postvaccinal reactions in patients and in СG was comparable.

Conclusions. The obtained results of the study indicate sufficient immunogenicity, clinical efficacy and safety of PPV-23 in patients with AS and Ps A.

This is a review of international and Russian recommendation for the study of anti-nuclear antibodies (ANA) in autoimmune inflammatory rheumatic diseases (AIRD) and autoimmune liver diseases (ALD), including a description of the most important methodological aspects. The main purpose of laboratory diagnostics of AIRD and ALD is to obtain objective information about the presence and immunopathological changes, which is an important tool for early diagnosis, assessment of activity, severity, prognosis of the disease and the effectiveness of therapy. The positive results of ANA determination are the main laboratory markers of AIRD and ALD, being among the diagnostic criteria for diseases. The ‘gold standard’ and primary screening method for determining ANA in serum is the indirect immunofluorescence assay (IFA). Antigen-specific solid phase assays methods are used as confirmatory tests. Standardization of the ANA determination contributes for reducing the intra- and inter-laboratory variability of the results, helps to optimize the interaction between laboratory specialists and clinicians in matters of prescribing and clinical interpretation of ANA tests. Solving the problem of ANA detection standardization is important because of the growing number of laboratories performing these tests and an increased referring for this investigation from rheumatologists and another medical specialist.

Purpose of the study. To evaluate the association of nutritional status with the presence of a sarcopenic body composition phenotype and obesity in postmenopausal women with rheumatoid arthritis.

Materials and methods. The study included 121 postmenopausal women with RA (mean age 62.1 ± 7.9 years). Nutritional status was determined using the Russian version of the Mini Nutritional Assessment (MNA) questionnaire. Body composition was studied using dual-energy X-ray densitometry (‘Whole Body’ program). Clinical and laboratory examinations were also carried out.

Results. Reduced nutritional status was detected in 42.1% of patients. Individuals with reduced nutritional status had a higher ESR and higher disease activity as assessed by the DAS28 index (p = 0.024 and p = 0.003, respectively), a greater 10-year likelihood of osteoporotic fractures of all major sites (p = 0.029) and hip fractures (p = 0.016). Correlations were established between nutritional status, according to the MNA questionnaire, and appendicular muscle mass (r = 0.21; p = 0.044), waist circumference (r = 0.32; p = 0.001) and waist-to-hip ratio (r = 0.29; p = 0.006), a negative association was found with DAS28 (r = –0.26; p = 0.009). Univariate logistic regression analysis showed an association of the sarcopenic phenotype with dietary calcium intake less than 500 mg/day (odds ratio [OR] = 7.55; 95% confidence interval [CI]: 3.09–18.44; p < 0.001), the shoulder circumference of the non-dominant arm is less than 25 cm (OR = 6.51; 95% CI: 2.21–19.12; p = 0.001). Obesity phenotype was associated with upper arm circumference greater than 25 cm (OR = 8.28; 95% CI: 2.78–24.66; p < 0.001) and serum vitamin D deficiency (OR = 1.04; 95% CI: 1.00–1.07; p = 0.043).

Conclusions. The incidence of reduced nutritional status in postmenopausal women with RA according to MNA was 42.1%. An association was found between MNA nutritional status, daily calcium intake and the sarcopenic phenotype. No association with nutritional status was found for the obesity phenotype.

Aim. To conduct a comparative analysis of the course of a new coronavirus infection (NCI) and post-Covid syndrome (PCS) caused by the Omicron strain and earlier strains in patients with rheumatic diseases (RD).

Materials and methods. 271 patients with NCI were included in the study. For a comparative analysis of the course of Covid-19 and PCS, two periods were defined: the first period was from March 2020 to December 2021 – early strains, the 2nd period was the appearance of the Omicron strain. In the analysed group, there were 214 (79 %) people who had early strains of Covid-19 and 57 (21 %) of Omicron. A comparative assessment of the presence of PCS and its characteristics was carried out 3, 6, 9, 12 months after Covid-19.

Results. Among patients who underwent NCI caused by early strains, CT-verified lung damage was recorded more often, which determined a higher frequency of hospitalizations. At the same time, the onset of Covid-19 presented with such symptoms as general weakness, lack of taste and smell; patients oftener bothered by periodic sensations of heat, increased body temperature, and shortness of breath. In the group of patients with NCI caused by the Omicron strain, comorbid pathology was determined oftener. PCS in groups of patients with NCI caused by early strains and the Omicron strain occurred with a frequency of 50.8% and 33.3%, respectively. In both groups, musculoskeletal manifestations remained the most common, with depression being commoner in the NCI group caused by early strains. The frequency of complaints characteristic of PCS remained at a high level for 6 months, a downward trend was noted by the 9th month after Covid-19. An increase in RD activity was found 3 months after the NCI in both groups.

Conclusions. In NCI caused by early strains, a moderate and severe course of the disease, as well as the development of PCD within 12 months, was more common. PCS symptoms were most severe between 3 and 6 months and decreased by the 9th month of follow-up. RD activity increased and oftener observed 3 months after Covid-19, regardless of the transferred strain, with a tendency to decrease activity 9 months after the NCI.

Background. Rheumatoid factor (RF) and antibodies to cyclic citrullinated peptide (ACCP) are associated with the progression of joint erosions in RA. Currently, the efficacy of anti-osteoporotic therapy for the prevention of erosive arthritis is discussing.

The aim of the study. To evaluate the effect of denosumab on the erosion score progression in patients with RA and OP, taking into account the activity of the disease and RF or ACCP positivity.

Materials and methods. The study included 66 postmenopausal women with determined diagnosis of RA and OP. Non-erosive arthritis was in 23 (35 %) patients, erosive – in 21 (32 %), ankylosis of the joints was diagnosed in 22 (33 %) people. RF (+) was detected in 47 (72 %) people, ACCP (+) – in 48 (74 %) people. Denosumab 60 mg was injected subcutaneously once every 6 months (two injections). The duration of follow-up was 12 months. RA activity was assessed by the DAS 28 index. The erosion was calculated according to the Sharp / van der Heijde (SVH) method.

Results. RA patients were divided into four groups: RF (+) and RF (–), ACCP (+) and ACCP (–), comparable in basic clinical features. At the same time, in the RF (+) group, the duration of RA, the frequency of ankylosis of the joints and the erosion count were initially higher compared to the RF (–). After 12 months of therapy, 7 (14.9 %) patients in the RF (+) group and 8 (16.7 %) patients in the ACCP (+) group the number of erosions has increased. There was no increase in the number of erosions in the RF (–) and ACCP (–) groups. In the analyzed groups, there were no changes in the erosion count depending on RA activity.

Conclusions. An increase in the erosion score was found in the RF (+) and ACCP (+) groups despite the treatment with denosumab. In the RF (–) and ACCP (–) groups this indicator did not change. The inclusion of denosumab in the complex therapy of RA and OP is reasonable for prevention of OP and erosions progression in women with seronegative RA.

Damage to the joints and spine is a frequent extra-intestinal manifestation of inflammatory bowel diseases (IBD). Studies show a genetic and immunological link between joint damage and intestinal inflammation. Oligo- and polyarthritis of small and large joints, arthralgia, ankylosing spondylitis may develop. Arthritis in IBD is seronegative, characterized by non-erosive and non-destructive lesions. Articular syndrome is more often associated with a severe course of IBD and a large extent of the lesion. Arthritis with IBD, basically, debuts simultaneously with intestinal inflammation or occurs after, but may precede the development of IBD. Joint damage can make its debut with a detailed clinical picture, cases of latent course are also described, which complicates the timely diagnosis. The combination of joint syndrome and intestinal inflammation requires an interdisciplinary approach.

Introduction. The quality of life in patients with osteoarthritis (OA) depends on the severity of functional disorders, pain syndrome and the efficacy of their pharmacological correction.

Purpose of the study. To evaluate the dynamics of the life quality in patients with knee osteoarthritis treated with intra-articular injections of domestically produced sodium hyaluronate (synovial fluid prosthesis) or with bioactive concentrate of small sea fish (BACSSF).

Materials and methods. 180 patients with knee osteoarthritis were examined. The study group consisted of 50 patients who received injections of sodium hyaluronate (prosthesis synovial fluid), intra-articularly. Comparison group included 30 patients treated with BACSSF 2 ml No. 5 intraarticularly. Control group consisted of 100 patients who received BACSSF intramuscularly 1 ml No. 20. Study design: duration 12 months with prospective monitoring of quality of life according to the SF-36 scale, six visits.

Results. When included in the study, the level of physical and mental health components between the groups of patients differed statistically insignificantly (p = 0.369 and p = 0.089). According to the study results, used pharmacotherapy improved quality of life in all groups. However, the groups differed statistically significantly in the speed of achieving an analgesic effect, the severity of pain reduction and the duration of maintenance of the therapy effect. The best dynamics of the physical and mental components of health was in a group of patients with knee osteoarthritis treated with intra-articular sodium hyaluronate.

Conclusions. In real clinical practice, it is not always possible to improve the quality of life of patients with knee osteoarthritis. Symptomatic delayed-release medications (SYSADOA) are effective in the early stages of the disease. The positive clinical effect of intra-articular therapy with sodium hyaluronate develops earlier and lasts longer than therapy with another SYSADOA (BACSSF).

Giant cell arteritis (GCA) is the most common primary systemic vasculitis that usually occurs in adults over the age of 50. According to the classification, GCA refers to vasculitis with damage to large vessels (aorta and/or its main branches), however, both medium and small arteries can be involved in the process. Typical is the involvement of the temporal, visual, occipital, vertebrate, posterior ciliary arteries. Temporal artery biopsy has been considered as the ’gold standard’ for the diagnosis of GCA for a long time. However, this procedure is not always feasible in real clinical practice, because of the invasiveness of the method and certain technical difficulties. Currently, the cheapest, fastest and safest way to diagnose GCA is ultrasonography (US) examination of arteries (temporal arteries, other cranial and extracranial arteries), which is included in the new classification criteria for GCA. Thanks to the wider use of US of the arteries, over the past few years, the diagnosis of GCA has significantly improved, which affects the adequacy of therapy positively and, therefore, the patient's long-term prognosis. Standardization of the examination procedure is important, and the analysis of US-images should be carried out by a qualified specialist, which also requires special training. The review presents the necessary technical requirements, characteristics of the equipment and the methodology for conducting a US-study, determining US-finds during GCA. Thus, a personalized approach to the diagnosis of GCA, based on clinical manifestations, available instrumental imaging methods (primarily ultrasound), is optimal for the rapid diagnosis of HCA and treatment.