Fibromyalgia (FM) is one of the most prevalent chronic diseases in the developed world, with a prevalence of 2–3 cases per 100 inhabitants. The predominant manifestation of FM is characterised by persistent generalized pain, frequently accompanied by a plethora of psychoemotional and dysfunctional disorders, including sleep disturbances, fatigue, anxiety and depression, headaches, irritable bowel syndrome, and numerous others. FM frequently occurs in conjunction with systemic rheumatic diseases. For instance, in rheumatoid arthritis and spondyloarthritis, the frequency reaches 20–30%.

Despite widespread interest, FM remains a largely understudied pathology to date. The diversity of clinical symptoms, excessive emotionality and difficult psychological mood of patients often determine difficulties in the diagnosis and treatment of this disease. This determines the need to form a clear algorithm of actions, which will help the general practitioner to successfully consult patients with suspicion of this disease, to conduct an effective diagnostic search and determine the possibilities of its complex therapy.

Introduction. Cryopyrin-associated periodic syndrome (CAPS) is an autoinflammatory disease that usually occurs in childhood and is characterized by episodes of unexplained fever combined with various organ lesions.

The aim is to analyze a clinical case of late diagnosis of cryopyrin-associated periodic syndrome that debuted in childhood. Materials and methods. A patient with a clinical picture of CAPS who repeatedly sought medical care at the outpatient level. An extended clinical, laboratory, and instrumental examination, including genetic analysis, was performed to conduct a differential diagnosis and verify the CAPS diagnosis.

Results. The clinical observation demonstrated that despite the classic debut of the disease in childhood with periodic fever and a burdened family history, the pediatrician did not have any concerns about the possible CAPS Subsequently, the progressive nature of the disease with severe skin manifestations, joint syndrome, eye damage, and sensorineural hearing loss were also neglected and did not considered as a reason for referring the patient to a rheumatologist. It was only when kidney damage and persistent inflammatory changes in the blood were detected that the possibility of a systemic rheumatic disease was suspected. The diagnosis of CAPS was established by a rheumatologist at in-patient clinic and confirmed by genetic test. The initiation of biological therapy with an interleukin‑1 inhibitor led to a rapid therapeutic effect.

Conclusions. Late diagnosis of orphan diseases remains an urgent problem in practical medicine. An adequate analysis of the clinical picture of the disease and family history is extremely important for the preliminary diagnosis of cryopyrin-associated periodic syndrome. The diagnosis is verified by genetic testing. Timely targeted therapy for CAPS is critical to prevent irreversible organ damage, primarily renal amyloidosis.

Asymptomatic hyperuricemia (AHU) and gout are pathological conditions characterized by elevated uric acid (UA) levels in the blood. Gout is characterized by acute arthritis attacks due to UA crystallization in the joints. Other differences between AHU and gout require further study.

Study objective. To identify key differences between AHU phenotypes.

Materials and methods. 220 patients with HU (UA >360 μmol/L) over 18 years of age were examined and divided into the following phenotypes: AHU; AHU with monosodium urate crystals (verified by ultrasound or synovial fluid analysis) (AHU+crystals); intermittent gout (G); tophaceous gout (G+tophi). Comparative characteristics of the groups included an assessment of the frequency of comorbidities, metabolic disorders, and the main laboratory parameters.

Results. According to phenotyping results, the group of patients with AHU included 40 people (18.2%), AHU+crystals – 26 (11.8%), G – 111 (50.5%), G+tophi – 43 (19.5). The average age in the groups was comparable (p=0.5). An increase in the frequency of hypertension and nephrolithiasis was revealed in the series AHU without crystals – AHU+crystals – G – G+tophi (p=0.0006 and p=0.00006, respectively). Similar patterns were found for the mean serum levels of UA (p=0.00001), creatinine (p=0.0003), and GGT (p=0.0003), the mean values of which increased sequentially from AHU to G+tophi. The maximum mean levels of CRP were in patients with G and G+tophi (5.3 [2.3; 12.5] mg/L), which was significantly higher than in AHU patients (p=0.04). GFR was lower in the G+tophi group compared to AHU (74.7±20.0 ml/min/1.73m² vs 86.8±17.9 ml/min/1.73m² , respectively, p=0.02).

Conclusions. The incidence of hypertension, nephrolithiasis, serum GGT and creatinine levels increases as HU progresses from AGU to G+tophi, which may reflect the intensity of chronic microcrystalline inflammation.

Difficult-to-treat rheumatoid arthritis (D2T RA) represents a complex clinical problem characterized by inefficacy of standard therapy and high disease burden. Despite the implementation of treat-to-target strategies and widespread use of biological (bDMARDs) and targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs), a significant proportion of patients fail to achieve remission or low disease activity, necessitating the definition of the D2T RA category. The working group established by the European Alliance for the Treatment of Rheumatic Diseases (EULAR) proposed a clear definition of D2T RA, including three mandatory criteria: inefficacy of several bDMARDs/tsDMARDs, presence of signs of active or progressive disease, and other circumstances complicating treatment. The prevalence of D2T RA ranges from 5% to 20%, with two-thirds of patients failing to achieve adequate control, and 40% developing drug resistance. Phenotypic heterogeneity of D2T RA manifests in various subgroups: those with inadequate treatment adherence, those with comorbidities, and those with persistent inflammation. Effective management requires a comprehensive approach, including optimization of comorbid conditions, lifestyle modification, and social support. A key challenge remains early identification of patients with D2T RA to enable timely personalized therapy.

Extracellular manifestations in Sjogren's disease are characterized by wide variability, affecting almost any organ or system, including the hematopoiesis system. Among the hematological manifestations of the disease, anemia syndrome is the most common. The article presents a clinical case of a patient in whom Sjogren's disease debuted with anemic syndrome, which led to a wide diagnostic search to clarify the diagnosis. Thus, the clinical case we observed is interesting not only from the standpoint of the importance of establishing a clinical diagnosis, but also the timeliness of treatment initiation, which affects the prognosis of the disease.

Objective. To evaluate the clinical efficacy of an original rehabilitation program incorporating hydrokinetic therapy (HKT) in patients with rheumatoid arthritis (RA) after primary total hip arthroplasty (THA).

Materials and methods. A prospective study included 81 patients with RA who underwent primary THA. The main group (n=31) received rehabilitation based on a proprietary program with HKT elements (Patent of Russia No. 2733686); the control group (n=50) underwent standard physical therapy. Functional outcomes, pain levels and recovery time were compared.

Results. The main group showed significant pain reduction (VAS: 0.5±0.3 vs. 1.5±0.3 cm; p=0.0067), improved functional outcomes (Harris score: 94±2.8 vs. 89±2.5; p=0.009), and earlier recovery of independent walking (7.4±0.65 vs. 9.5±0.57 weeks; p < 0.0001).

Conclusion. Integration of HKT into the rehabilitation program after THA in RA patients improves functional outcomes, reduces pain, and accelerates recovery. The method is recommended for clinical use.

Objective. To demonstrate the role of a primary care specialist, a district therapist, in the diagnosis and subsequent monitoring of a rare and difficult-to-recognize disease, eosinophilic granulomatosis with polyangiitis (EGPA), characterized by multiple organ damage, using a clinical case example.

Materials and methods. This article presents a clinical case of a 72-year-old patient with EGPA. The stages of diagnostic search are described, including the patient's initial visit to a district therapist, analysis of the patient's medical history, physical examination, laboratory and instrumental tests, verification of the diagnosis by a rheumatologist, as well as the treatment and monitoring of the patient's condition.

Results. A case of a patient with ECPA manifestation after a long remission of bronchial asthma, with a predominance of neurological symptoms (ischemic stroke, polyneuropathy), subclinical damage to the heart (complete blockade of the left bundle branch, hydropericard), and kidneys is described. Presented case demonstrates the role of a primary care specialist – a district therapist – in the diagnosis and subsequent monitoring of a rare and difficult-to-recognize disease, eosinophilic granulomatosis with polyangiitis (EGPA), characterized by multiple organ damage. Timely and adequate therapy led to clinical and laboratory remission.

Conclusion. This clinical case demonstrates the importance of the district therapist's alertness regarding rare diseases such as EGPAs, especially in the presence of bronchial asthma and eosinophilia. The need for a comprehensive examination of patients with multiple organ pathology is emphasized. Timely diagnosis and adequate therapy contribute to achieving remission. In the future, it is important to monitor the patient to prevent relapses and treat associated diseases. Despite the fact that the diagnosis and treatment of EGPAs are the responsibility of a rheumatologist, the early diagnosis and referring the patients to a specialist depend largely on the district therapist.

This article provides a comprehensive analysis of current understanding of the role of the apelinergic system in the pathogenesis of rheumatic diseases. The molecular mechanisms of the apelin/APJ system functioning and its involvement in key pathological processes are examined. Particular attention is paid to the dysregulation of this signaling pathway in various nosological forms of rheumatic pathology, including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis and spondyloarthritis. Contemporary data establishing the relationship between disorders of the apelinergic system and the development of systemic inflammation, endothelial dysfunction and fibrotic tissue remodeling are systematized. However, certain aspects of the apelin/APJ system functioning remain insufficiently studied and require further investigation. Of particular scientific importance is the clarification of the molecular basis of apelin/APJ interaction with pro-inflammatory signaling pathways. Based on recent advances in molecular medicine, the prospects of innovative approaches to modulating the apelin/APJ system using biotechnological methods are discussed, opening possibilities for developing new pathogenetic treatment strategies for rheumatic diseases. The review specifically addresses the potential of selective agonists and antagonists of this signaling pathway, as well as opportunities for targeted correction of its activity at different regulatory levels. Special consideration is given to the dual nature of apelin/APJ system effects in different tissue environments and pathological contexts. The analysis of potential diagnostic applications of apelinergic system components as biomarkers for disease activity monitoring and prognosis evaluation is also presented.

Aim. To evaluate the dynamics of laboratory inflammation markers (ESR, CRP) in rheumatoid arthritis patients over 12 months with in-person outpatient monitoring and a combination of in-person monitoring and remote digital monitoring of patients' condition.

Materials and methods. The study included 2 comparable groups – remote and traditional monitoring (RM and TM) of 35 patients with an established RA. The condition of patients in the RM group was assessed by a doctor remotely using questionnaires in the remote monitoring program every month, as well as face-to-face visits after 6 and 12 months. In case of deterioration or insufficient positive dynamics of indicators, patients had the opportunity for remote or face-to-face consultation with a doctor and treatment adjustment. Patients in the TM group visited a doctor according to clinical guidelines after 3, 6 and 12 months. After 6 and 12 months, a comparative assessment of the dynamics and final levels of ESR and CRP was carried out.

Results. Reliable differences between the groups in ESR and CRP were found both after 6 and 12 months of observation: the median ESR in the RM group was 6 mm/h lower after 6 months and 4 mm/h lower after 12 months than in the TM group (p < 0.001). Patients in the RM group had lower CRP values than in the TM group: 2.00 [0.95; 3.00] versus 3.01 [1.60; 6.30] after 6 months of observation and 1.10 [0.60; 2.50] versus 2.90 [1.30; 5.45] after 12 months.

Conclusion. The study presents a clinical experience of using remote monitoring of RA patients. By more closely monitoring patients' condition using a combination of remote digital monitoring and in-person observation, the intervention group achieved better control of the inflammatory laboratory markers ESR and CRP compared to the group without remote monitoring.

The aim. To study the effect of type 2 diabetes mellitus on the state of the cardiovascular system in patients with rheumatoid arthritis.

Materials and methods. Patients diagnosed with RA were included in the study in the order of their appointment with a rheumatologist and, depending on the presence of such a concomitant disease as type 2 diabetes mellitus, were divided into 2 groups: group 1 (n=262) – patients with RA, group 2 (n=53) – patients with RA and type 2 diabetes. Further, all the examined underwent a comprehensive laboratory and instrumental examination.

Results. Among patients with RA and type 2 diabetes, the body mass index (32,4±0,89 vs 28,3±0,28, р < 0,0001) and the relative wall thickness of the left ventricle (0,446±0,01 vs 0,42±0,004, р=0,04), the level of leukocytes (8,93±0,33 vs 7,24±0,17, р=0,0002) and neutrophils (63,16±1,76% vs 56,7±1,02%, р=0,02), NLR indices (2,92±0,33 vs 2,17±0,12, р=0,01), SII (925,5±146,8 vs 648,7±47,31, р=0,02), SIRI (1,98±0,19 vs 1,42±0,09, р=0,01) and significantly lower total cholesterol (4,88±0,19 vs 5,7±0,09, р=0,0002), low-density lipoproteins (2,86±0,26 vs 3,75±0,13, р=0,007), high-density lipoproteins (1,185±0,06 vs 1,55±0,04, р=0,003).

Conclusions. The presence of type 2 diabetes mellitus in patients with rheumatoid arthritis has a multidirectional effect on the state of the cardiovascular system. These results may have important implications for the management and treatment of patients with a combination of rheumatoid arthritis and type 2 diabetes mellitus.

Rheumatoid arthritis (RA) is a chronic autoimmune systemic disease, in the development and progression of which significant manifestations of internal organ and system pathology are observed, with gastrointestinal tract lesions accounting for 11%.

The aim of the study: comprehensive examination of the state of the hepatobiliary system (HBS) in patients with RA depending on the treatment regimen.

Material and methods. 35 patients with predominantly early manifestations of RA were under observation. All were either newly started on anti-inflammatory therapy, or received it irregularly. 12 patients received only non-steroidal anti-inflammatory drugs (NSAIDs), 13 – NSAIDs in combination with «disease-modifying antirheumatic drugs» (DMARDs) (methotrexate, hydroxychloroquine), and 10 patients underwent complex treatment – NSAIDs+ hydroxychloroquine +oral glucocorticoids.

Results and discussion. The fact that this functional impairment is due to the active rheumatoid process, and not only to toxic-dystrophic changes in the liver and gallbladder occurring in weakened, long-suffering patients taking numerous medications, is evidenced by the change in the activity of the main biochemical syndromes (especially the mesenchymal-inflammatory and cytolytic syndromes) as the duration of the disease increases, with a more severe course of RA, in the presence of systemic manifestations, increased disease activity, and a tendency for indicators to normalize as a result of complex therapy. Supporting this assumption are the results of a study of the functional state of the hepatobiliary system in relatively newly diagnosed and untreated or inadequately treated patients.

Conclusions. Treatment of rheumatoid arthritis with «disease-modifying antirheumatic drugs» and glucocorticosteroids has a positive effect on the functional state of the liver in terms of correcting biochemical syndromes: cytolysis, cholestasis, hepatocellular failure, and mesenchymalinflammatory, which are markers of chronic hepatitis.