One of the commonest manifestations of systemic lupus erythematosus (SLE) is skin damage. In addition to classic lupus erythema and subacute cutaneous lesion, deep damage to the subcutaneous fat, known as lupus panniculitis, can occur. The formation of subcutaneous nods, followed by atrophy, is not only a cosmetic issue but also indicates the presence of active immune inflammation. This phenomenon needs the attention of clinicians, as it requires careful differential diagnosis and aggressive disease-modifying therapy. The article presents a clinical observation demonstrating a rare skin manifestation of SLE – lupus panniculitis in a young patient with a SLE family history. The disease debuted in adolescence with a skin syndrome, which led to the initial diagnosis of discoid lupus. Subcutaneous nodes began to appear early on, and anti-nuclear factor (ANF) was positive. Subsequently, antibodies to native DNA were detected, and hematological and joint manifestations presented, what enabled the diagnosis of SLE two years after   onset, while the presence of panniculitis was not indicated in the diagnosis formulation. The standard therapy for SLE did not result in remission or low disease activity. Due to the persistent activity of SLE and the predominance of skin manifestations, the patient was treated with the biological drug anifrolumab. Combined therapy including anifrolumab led to a rapid regression of skin manifestations, lupus panniculitis was completely resolved, and activity decreased to the level of minimal. Thus, anifrolumab proved to be a highly effective therapeutic option in the treatment of lupus panniculitis.

According to the recommendations of the ELUAR expert committee, the choice of drug therapy for calcium pyrophosphate deposition disease (CPPD) is based on the clinical presentation (phenotype) of the disease. However, it is unknown whether this approach is implemented in real clinical practice. The aim of the study was to analyze the frequency of use of drugs prescribed for the treatment of CPPD in various phenotypes of the disease. Materials and methods. A total of 266 patients with CPPD over 18 years of age with clinical symptoms were examined. These patients were divided into phenotypes: recurrent acute arthritis, chronic arthritis, and osteoarthritis (OA) with calcium pyrophosphate (CPP) crystals. The frequency of prescription of colchicine, methotrexate, hydroxychloroquine, glucocorticoids (GCs), and nonsteroidal anti-inflammatory drugs (NSAIDs) was compared. Results. Based on phenotyping results, the group of patients with acute arthritis consisted of 40 patients (15 %), chronic arthritis – 157 (59 %), and OA with PFK crystals – 69 (26 %). The frequency of medications used to treat CPPD in all study participants (n=266): 207 patients (77.8 %) received NSAIDs, 97 (36.5 %) colchicine, 46 (17.3 %) hydroxychloroquine, 60 (22.6 %) methotrexate, and 34 (12.8 %) GCs. In acute arthritis, 30 patients (75 %) received NSAIDs, 5 (12.5 %) GCs, 17 (42.5 %) colchicine, 4 (10 %) hydroxychloroquine, and 8 (20 %) methotrexate. Patients with chronic arthritis: 123 (78.3 %) NSAIDs, 21 (13.4 %) – GCs, 58 (36.9 %) – colchicine, 29 (18.5 %) – hydroxychloroquine, 40 (25.5 %) – methotrexate. Patients with OA with CPP crystals: 54 (78.3 %) – NSAIDs, 8 (11.6 %) – GCs, 22 (31.9 %) – colchicine, 13 (18.8 %) – hydroxychloroquine, 12 (17.4 %) – methotrexate. Conclusions. The most commonly used medications for CPPD are NSAIDs and colchicine, with no significant differences in the frequency of prescription of individual medications across different disease phenotypes. The use of low-dose colchicine in CPPD appears to be the most appropriate.

Objective. To assess rheumatoid arthritis (RA) activity and the adequacy of ongoing conventional disease-modifying anti-rheumatic therapy in outpatients in real-world clinical practice. Materials and methods. A total of 115 outpatients with RA who consulted a rheumatologist were examined. Disease activity was assessed using the DAS 28-CRP index; the physician’s global assessment of activity, the ratio of tender to swollen joints, and the results of the HADS and FIRST questionnaires were also taken into account. The effectiveness of regular follow-up was analyzed. Results. According to DAS 28-CRP, remission/low disease activity was identified in 43.7 % of patients, moderate activity in 42.7 %, and high activity in 13.6 %. At the same time, objective signs of inflammatory activity (elevated CRP and ≥1 swollen joint) were observed in only 22.3 % of patients. In 34.0 % of patients, DAS 28 overestimated disease activity; this was associated with anxiety, depression, or fibromyalgia. Signs of at least one of these comorbid conditions were detected in 52.6 % of the patients examined. The effectiveness of regular follow-up was demonstrated: high RA activity was observed in 32.1 % of patients with irregular rheumatology visits, whereas among patients seen by a rheumatologist every 6 months or more frequently, high RA activity was recorded in 12.0 % (p=0.014). In 18.4 % of patients, the potential of basic therapy had not been fully exhausted. Conclusions. The DAS 28-CRP index may overestimate RA activity due to subjective factors; therefore, screening for anxiety, depression, and fibromyalgia appears advisable. Control of RA activity improves with regular patient follow-up, indicating the need to establish structured dispensary monitoring.

Objective. To assess the impact of systematic rheumatologic supervision on the outcomes of total hip arthroplasty (THA) in patients with rheumatoid arthritis (RA) through retrospective analysis. Materials and methods. This study analyzed data from 194 RA patients who underwent primary THA. The main group (n=143) received regular rheumatologic care, while the comparison group (n=51) did not. Outcomes assessed included the presence of osteoporosis, acetabular defects, intraoperative blood loss, surgical techniques, and functional results. Results. Patients under regular rheumatologic care had a lower incidence of osteoporosis (47.6 % vs. 70.6 %; p=0.0054), reduced blood loss (320±102 ml vs. 375±110 ml), and better clinical outcomes (DAS 28 improved from 4.6 to 2.6; p<0.01; short-HAQ and Harris Hip Scores also improved). Those without rheumatologic supervision required more frequent bone grafting and screw fixation. The highest blood loss was observed in patients   receiving glucocorticoids (up to 450 ml; p<0.0001). Conclusion. Systematic rheumatologic management before, during, and after THA significantly reduces surgical risks and improves both anatomical and clinical outcomes in RA patients. It should be considered an essential component of comprehensive care in joint replacement surgery.

Goal. Comparative analysis of initial treatment adherence in patients with various inflammatory diseases of the joints and spine. Materials and methods. A total of 91 women aged 18 to 65 years who were diagnosed with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) were examined according to current criteria. The average age was 51 years, the average duration of the disease was 10 years, and the average age at onset was 41 years. Treatment adherence was assessed using the MMAS-4 and COP-25 questionnaires. The statistical analysis was performed using the StatTech v. 4.9.5 software (developed by Stattech LLC, Russia). Results. The results of the study demonstrate that the level of treatment adherence in women with chronic inflammatory diseases of the joints and spine remains generally insufficient. According to the results of MMAS-4, 28.6 % of all patients were committed to drug therapy. According to the results of the COP-25, the overall commitment was 57.22 %. There was no correspondence between the indicators of qualitative (MMAS-4) and quantitative (CPC-25) treatment adherence questionnaires. The lowest adherence in all areas of treatment was demonstrated by patients with RA – their total adherence was 52.41 %, which corresponds to the borderline of medium and low levels of adherence. Patients with PsA were slightly more committed (55.11 %). Patients with AS demonstrated 67.10 % adherence to treatment in general, which corresponded to the average level of adherence and was significantly higher than for other diseases.The most vulnerable aspect is lifestyle modification.Young age is associated with a higher commitment to treatment. Conclusion. Women with inflammatory diseases of the joints and spine have an average and low level of adherence to various treatment components, which may be one of the mechanisms for the formation of the phenotype of «difficult to treat» patients with RA, AS, and Ps A. The findings highlight the need for comprehensive commitment enhancement strategies combining pharmacological, educational, behavioral, and psychological approaches

Title. Assessment of the impact of osteopathic correction of somatic dysfunctions on pain intensity, functional status, and average daily paracetamol requirement in patients with gonarthrosis (GA) and metabolic syndrome (MS). Methods. A single-center, randomized, prospective study evaluating the clinical course of GA in patients with MS (n=49) was conducted. Patients were blindly allocated into two groups: the main group (n=20) received pharmacotherapy (chondroitin sulfate 1000 mg/day, glucosamine hydrochloride 1000 mg/day, paracetamol 500–1000 mg/day as needed) plus a course of osteopathic correction (4 sessions); the control group (n=29) received pharmacotherapy alone according to the same regimen. Treatment outcomes were assessed at baseline and on day 30 using the VAS, WOMAC index, daily paracetamol dose, and severity of somatic dysfunctions (main group only). Statistical analysis was performed using nonparametric tests: the Wilcoxon signedrank test for withingroup comparisons and the Mann–Whitney U test for betweengroup comparisons. Data are presented as median (25th, 75th percentiles) and the χ² test for categorical variables. Differences were considered statistically significant at p<0.05. Results. Both groups showed a significant reduction in VAS pain scores and WOMAC index (p<0.01) with no intergroup differences. In the main group, paracetamol requirement decreased from 1000 to 500 mg/day (p<0.01), whereas it remained unchanged in the control group. The severity of somatic dysfunctions in the main group decreased from 2.1 to 1.5 points (p<0.01). Conclusion. The use of osteopathic correction techniques for somatic dysfunctions in the complex treatment of patients with GA contributes to a twofold reduction in the need for paracetamol while maintaining a comparable analgesic effect in the short-term observation period and,   therefore, reduces the potential risks of its adverse effects that develop when it is used in patients with MS.

An imbalance in the production of pro- and anti-inflammatory cytokines plays a significant role in the pathogenesis of rheumatoid arthritis (RA). Seropositivity for IgM rheumatoid factor (RF) and/or antibodies to cyclic citrullinated peptides (ACCP) determines disease subtypes. The aim of the study. To conduct a cluster analysis of the profile of pro- and anti-inflammatory cytokines detected in the blood serum of RA patients with an advanced stage of the disease in comparison with healthy individuals, the presence of IgM RF and ACCP in patients. Materials and methods. The study included 154 RA patients (41 men and 113 women of middle age 56.0 [50.0; 64.0] years), disease duration 9.4 [3.0; 13.0] years), seropositive 129 (83.8 %) for IgM RF and/or 106 (68.8 %) ACCP with moderate or high (DAS 28-ESR – 5.40 [4.65; 6.00]) disease activity. Serum concentrations of interleukins (IL), tumor necrosis factor α (TNF-α), interferon-γ (INF-γ) and soluble CD 40 ligand (sCD 40L) were determined using multiplex technology. Hierarchical clustering of cytokines was performed in 20 healthy individuals and RA patients using Ward’s method. In RA, a comparison was made between seronegative and seropositive groups for IgM RF/ACCP. Results. In healthy individuals, the cytokine network exhibited a physiological organization. Cytokines were grouped into compact, well-defined modules with minimal cross-links between individual components. A dominant proinflammatory core of cytokines was absent, and a balanced cytokine network was observed. IL-4 and IL-10 formed an integral and stable part of the regulatory component. In RA, the cytokine network underwent a dramatic reorganization caused by systemic inflammation. The network architecture became significantly more complex and fragmented, with the formation of four highly stable modules. The first was composed of IL-1β and TNF-α; the second included the cytokines of the IL-17A, IL-17F, and IL-23 axis; the third included IL-6 and IFN-γ; and the fourth included IL-4, IL-10, IL-31, IL-33, and sCD 40L. Analysis of the cytokine hyperproduction diagram revealed the IL-33 cluster. In patients seronegative for IgM RF, four modules are formed. The first is formed by IL-17A, IL-23, IL-25, and IL-17F; the second by IL-1β and IFN-γ; the third includes IL-33, IL-6, and IL-10; and the fourth includes TNF-α, IL-31, sCD 40L, and IL-4. In the IgM RF-seropositive variant of RA, the network architecture became significantly more complex and fragmented. A greater number of modules were identified. The first was formed by IL-23 and IL-17F; the second by IL-1β, IL-25, and IL-17A. TNF-α was embedded in each of them. The third module included IFN-γ and IL-6, the fourth – IL-31 and sCD 40L, the fifth – IL-33 and IL-4. IL-10 is more similar to the first two. In the patient groups with and without ACCP, the component architecture was similar for both the seronegative and IgM RF-seropositive variants of the disease, with minimal differences. The most pronounced and clear differences between the compared groups were obtained when analyzing the patient groups with and without IgM RF and/or ACCP. Conclusions. The results of cluster analysis demonstrate significant differences in the cytokine network architecture in RA compared to the control group, with the identification of a distinct IL-33 cluster. Differences are also observed between seronegative and seropositive subtypes of the disease.

The aim. To evaluate the possibility of using fecal calprotectin levels for early diagnosis of inflammatory bowel diseases in patients with AS in real clinical practice. Materials and methods. The analysis included 70 patients with a confirmed diagnosis of AS over the age of 18: 52 men (74.3 %) and 18 women (25.7 %), aged 47.4±8.8 years, with a disease duration of 19.6±7.9 years. All patients underwent blood tests (ESR, CRP, HLAB 27 antigen levels), esophagogastroduodenoscopy and colonoscopy, quantitative analysis of the fecal calprotectin levels using the method of lateral immunochromatography with the BUHLMANN Quantum Blue rapid test (standart range: 100–1800 μg/g). Results. All patients had high disease activity: BASDAI was 5.4±1.4, ASDAS CRP – 3.6±0.8. IBD was diagnosed in 18 cases (25.7 %). In 77 % of patients with AS, the FC level exceeded 100 μg/g, and in 28 % it exceeded 1800 μg/l. The FC level was more than 1000 μg/g in 63 %. In patients with IBD, the FC level was more than 100 μg/g, and the average FC level was higher in patients with IBD (1141.3 μg/g) than without IBD (787 μg/g). No active IBD was detected in all patients with FC levels less than 300 μg/g of feces. FC levels correlated with CRP (r=0.366) and ESR (r=0.366) (p<0.001). A positive HLAB 27 antigen was found in all patients with IBD. Conclusion. Patients with AS and IBD had higher FC levels than patients without IBD. Normal FC levels in patients with AS indicate the absence of intestinal inflammation. There was also a correlation between increased FC levels and the severity of AS. According to the study, measuring fecal calprotectin levels may be useful for detecting intestinal inflammation at an early stage.

Interstitial lung disease (ILD) is the most severe extra-articular manifestation of rheumatoid arthritis (RA) and one of the most frequent causes of death in these patients. Treatment of ED in RA is still a subject of debate. Ideally, it should be aimed at controlling the activity of joint pathology, preventing healing or slowing the progression of lung damage, in particular fibrotic changes. Antirheumatic drugs that modify the course of RA are used in daily practice, but their effectiveness in ILD has not been proven, although good control of systemic disease can improve the prognosis for patients. Immunosuppressants, which are commonly recommended for the treatment of ILD associated with immune-inflammatory rheumatic disease, often have low efficacy against RA. Therefore, in order to determine the optimal therapeutic strategy for a particular patient, an interdisciplinary discussion is usually required, including at least a rheumatologist and a pulmonologist. This article will review the currently available RA-ILD treatment options, with an emphasis on their possible use in accordance with current knowledge about the pathogenesis and clinical development of this disease.