Objective: to evaluate the efficacy and safety of complex therapy for knee osteoarthritis (OA) using a combination of chondroitin sulfate (CS) and glucosamine (G), as well as intra-articular (IA) administration of a medical device (MD) containing polyacrylamide gel (PAAG).Material and methods. The study included 22 patients aged 40–75 years with definite knee OA, radiographic stage II–III. Median age was 64.5 [59.0; 68.0] years. All patients received comprehensive therapy: a single IA injection of 4.0 ml of the PAAG-containing MD into the target knee in combination with oral CS (800 mg/day) and G (1000 mg/day) for 6 months. Total follow-up duration was 9 months (6 months of treatment and 3 months of follow-up).Results and discussion. During complex therapy, a significant reduction in knee pain intensity on the visual analog scale was observed, along with improvement in all WOMAC components, patient global assessment of health status, the Lequesne index, and quality of life according to EQ-5D (p<0.05 for all). Patients and physicians rated the treatment results highly: improvement and significant improvement were recorded in 90.91% of cases. Therapy was associated with a statistically significant reduction in the need for nonsteroidal anti-inflammatory drugs: 77.27% of patients discontinued their use already 1 month after study initiation. A significant decrease in CRP level was also recorded (p<0.05).Conclusion. The study results confirm the significant efficacy and safety of a complex approach to OA therapy, including the use of a combination of disease-modifying drugs for OA and IA administration of an MD containing PAAG.
Objective: to identify a set of criteria for the differential diagnosis of axial spondyloarthritis (axSpA) and axial psoriatic arthritis (axPsA).Material and methods. A total of 222 patients were examined: 108 with axSpA (Group 1) and 114 with axPsA (Group 2). Group 1 included patients meeting the axSpA criteria; Group 2 included patients with PsA who had axial involvement and met the CASPAR criteria. Axial involvement was diagnosed in the presence of radiographically definite (rd) sacroiliitis (SI), i.e., bilateral SI grade ≥II or unilateral SI grade ≥III, or active SI on magnetic resonance imaging, or ≥1 syndesmophyte in the cervical spine (C-spine) and/or lumbar spine. Inflammatory back pain (IBP) was defined according to the ASAS criteria. Radiographs of the hands and feet were performed. A multivariate analysis method was used (classification tree construction).Results and discussion. Patients with axPsA were characterized by onset of back pain after the age of 45 years, the presence of polyarthritis with a tender joint count >5 and a swollen joint count >3, dactylitis, skin and nail psoriasis, osteolysis, joint ankylosis, extra-articular bone proliferation, and multiple erosions. Distinctive features included syndesmophytes in the cervical spine, asymmetric, non-bridging, bulky syndesmophytes, spinal changes in the absence of SI, and the presence of rdSI that developed without IBP. Patients with axSpA were characterized by a younger age (<40 years) at diagnosis, presence of IBP, spinal involvement without peripheral arthritis, heel enthesitis, uveitis, inflammatory bowel disease, family history of SpA, HLA-B27 positivity, and the presence of rdSI and sacroiliac joint ankylosis.Conclusion. Classification tree construction made it possible to determine that the differential diagnosis is based on features such as the presence or absence of psoriasis in combination with peripheral symptoms (joint swelling, severe arthralgia) and radiographic signs of osteolysis.
Chronic pain is the most burdensome manifestation of rheumatic diseases (RD), a syndrome with a complex multifactorial pathogenesis and a serious threat to the patient’s health and life. It develops when acute pain is insufficiently controlled, against the background of persistent inflammation, degenerative processes, dysfunction of the nociceptive system, and psycho-emotional disturbances. The leading strategy of analgesic therapy in RD is a multimodal approach using drugs and treatment methods targeting the main elements of pain pathogenesis. For pain relief in diseases of the joints and spine, paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids are generally used. One way to increase the effectiveness of analgesic therapy is a rational combination of analgesics. In particular, combined use of NSAIDs and paracetamol increases treatment efficacy by 30–40%. Given that most patients with RD are older individuals with comorbid cardiovascular diseases, the use of naproxen in combination products is of great interest. This NSAID has high analgesic potential and, at the same time, the best cardiovascular safety profile. Therefore, a new drug comprising a combination of naproxen 275 mg and paracetamol 500 mg, which has recently entered Russian medical practice, can be considered one of the most successful tools for controlling musculoskeletal pain in RD.
The pathogenesis of autoimmune rheumatic diseases is a complex multifactorial process based on activation of various components of the immune system. One of the approaches to the treatment of these diseases is extracorporeal therapy technologies, which are techniques aimed at removing from the blood the components involved in pathogenesis and leading to tissue damage. This review discusses various therapeutic apheresis techniques used for the treatment of systemic lupus erythematosus.
Objective: to evaluate the long-term outcomes of cementless total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS).Material and methods. This retrospective study included 30 patients with AS who underwent THA between 1998 and 2018. Complaints, pain intensity assessed by a visual analog scale (VAS), medical history, therapy for the underlying disease, orthopedic status, hip function assessed by the HHS, and operative parameters were evaluated. We also recorded subjective satisfaction with surgery according the SHV questionnaire, as well as complications and revision procedures. Patients were followed up for a mean of 13.7 years.Results and discussion. Mean HHS before surgery was 43.1 points and 86.7 points at long-term follow-up (p=0.001); VAS pain level was 72.3 mm and 20.8 mm, respectively (p=0.001). A good or excellent subjective assessment of surgery was reported by 87% of patients. Periprosthetic femoral fractures were diagnosed in 2 (4.2%) patients and did not require reoperation. Over the follow-up period, two revision THA procedures were performed due to polyethylene liner wear (4.16%).Conclusion. In AS patients with hip involvement, cementless THA provided good long-term functional outcomes. Complications were rare.
Systemic lupus erythematosus (SLE) and systemic vasculitides associated with antineutrophil cytoplasmic antibodies (ANCA-associated vasculitides, AAV) are severe chronic autoimmune diseases with multisystem involvement. Despite substantial differences in pathogenesis, they share frequent and prognostically unfavorable kidney involvement, which largely determines the course and outcome of the disease. The use of the classic invasive method for dynamic assessment of renal pathology – percutaneous kidney biopsy – has serious limitations. Therefore, the search for noninvasive biomarkers that allow evaluation of glomerulonephritis activity becomes particularly relevant. For this purpose, in particular, monocyte chemoattractant protein 1 (MCP1/CCL2), soluble CD163 receptor (sCD163), integrin CD11b, calprotectin, and others may be used. Such “liquid biopsy” components of the kidney may have significant diagnostic and prognostic value in SLE and AAV.
Antineutrophil cytoplasmic antibody-associated systemic vasculitides (AAV) are a heterogeneous group of multisystem diseases characterized by inflammation and necrosis of the vessel wall of small- and medium-sized vessels. The international community subdivides them into three nosological forms: granulomatosis with polyangiitis (GPA), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis. The epidemiology of this disease in children has been insufficiently studied. In the Russian Federation, there is no unified registry of patients with this diagnosis; in foreign studies, only a very limited view of the problem is presented due to small sample sizes and difficulties in defining inclusion criteria for the study group. Early diagnosis remains a challenging clinical task.The article describes two clinical cases of GPA in children and presents methodological approaches to disease diagnosis and treatment. A comparative analysis of GPA development in 17- and 10-year-old female patients was performed. Diagnostic methods for GPA in the absence of ANCA and the need to implement lung biopsy as the “gold standard” in ANCA-negative status are discussed.
Genetic polymorphism of the IL-6 gene (-174 G/C, rs1800795) may affect interleukin-6 expression and contribute to the development of age-associated phenotypes of rheumatoid arthritis (RA).Objective: to study the distribution of IL-6 gene alleles and genotypes in RA patients depending on age at onset (AAO).Material and methods. The study included 167 patients with RA. Group 1 included patients with RA AAO ≤45 years (median AAO 36 [29; 42] years; n=95); Group 2 included patients with RA AAO ≥60 years (median AAO 66.5 [62; 70] years; n=72). DNA from 301 healthy donors served as controls. All patients underwent genotyping of IL-6 gene polymorphisms using polymerase chain reaction.Results and discussion. In patients with AAO ≥60 years, the CC genotype was detected more often than in patients with AAO ≤45 years (31.9% vs 12.6%, respectively; p=0.01). In RA patients with the CC genotype, the risk of developing the disease at the age of ≥60 years was almost three times higher compared with carriers of other genotypes (odds ratio 3.25; 95% confidence interval 1.39–7.65; p=0.004).Conclusion. The established association of the CC genotype of the -174 G/C polymorphism of the IL-6 gene with the development of RA after 60 years allows this genetic variant to be considered a predictor of RA onset in older age, which supports the rationale for stratifying RA by agerelated phenotypes and opens prospects for the development of diagnostic and preventive approaches.
Febuxostat was originally developed as a treatment for hyperuricemia in patients with gout; however, studies in recent years have demonstrated broader therapeutic potential beyond its urate-lowering effect. The main mechanism of action of febuxostat is inhibition of xanthine oxidase activity, which leads to a reduction in serum uric acid levels. It is assumed that other mechanisms of action of not lesser importance are related to involvement in immune processes and contribute to suppression of both local and systemic inflammation; it also has an antioxidant effect. The drug should be considered safe in patients with cardiovascular diseases and is characterized by low hepatotoxicity. In addition to the established renoprotective effect of febuxostat, consisting in slowing the progression of chronic kidney disease, its potential use in other diseases is currently being considered, in particular in osteoarthritis, nervous system and pulmonary diseases, inflammatory bowel diseases, and COVID-19.
Cardiac involvement is one of the severe manifestations of systemic sclerosis (SSc), ranging from subclinical forms to life-threatening conditions, and is characterized by poor prognosis and high mortality. Cardiopathy in SSc may be primary or secondary, associated with comorbid conditions. Therefore, timely diagnosis of primary cardiac involvement is of particular importance, including the assessment of serum biomarkers.This review discusses laboratory biomarkers for the detection of primary cardiac involvement in SSc, their role in early diagnosis, and their value in predicting disease course.
Psoriatic arthritis (PsA) is a chronic inflammatory disease of the joints, spine, and entheses that can develop in patients with psoriasis. PsA is primarily characterized by inflammation of peripheral joints (arthritis), fingers and toes (dactylitis), and entheses (enthesitis); inflammation may also occur in axial structures – the vertebral bodies (spondylitis) and the sacroiliac joints (sacroiliitis). At present, the use of imaging methods to identify musculoskeletal involvement in rheumatic diseases is an integral part of the diagnostic process. In recent decades, the high sensitivity of ultrasound for detecting joint abnormalities has been widely discussed. This method makes it possible to more accurately assess the presence of inflammatory signs in joints and extra-articular structures, which is important for diagnosis and further monitoring of disease activity.
Objective: to assess the prevalence of systemic lupus erythematosus (SLE) in the Russian population of patients with reproductive health problems (RHP).Material and methods. Patients were enrolled in 2023–2024 at 15 clinical centers in 5 federal districts of the Russian Federation. Women referred by a gynecologist, reproductive specialist, or general practitioner to a rheumatologist to rule out a systemic autoimmune rheumatic disease (SARD) were included. The study comprised two visits: the first screening visit and the second (final, 2–6 weeks later) visit, during which SARD verification was performed. Descriptive statistics methods were used for data analysis. The frequency of features in two independent study groups was compared using χ2 (Pearson’s test), odds ratios with 95% confidence intervals. The association between antibody levels and clinical manifestations was assessed by constructing a regression model.Results and discussion. Of 631 women examined, 612 (97.0%) met the inclusion criteria; 19 women were excluded because they did not have RHP (infertility or pregnancy loss) and/or signs of SARD. Antinuclear factor (ANF) was determined in 590 of 612 women. ANF positivity was detected in 238 (40.3%) of 590 patients. Of these 238 women, antinuclear antibodies were detected in 71, and decreased complement component levels were found in 55 (C3 in 28 and C4 in 27). SARD was diagnosed in 71 (11.6%) cases: SLE in 27 (4.4%) (definite in 23 and probable/incomplete in 4), mixed connective tissue disease was newly diagnosed in 36 (5.9%), Sjцgren’s disease in 4 (0.7%), and systemic sclerosis in 4 (0.7%). Among ANF-positive patients with RHP, 167 (70.2%) of 238 had no SARD.Conclusion. In this multicenter pilot study, the frequency of SLE in the Russian population among women with RHP was 4.4% (27 of 612 women), and the overall frequency of SARD was 11.6% (71 of 612). ANF positivity occurred more than three times (40.3%) more often than newly diagnosed SARD cases, indicating the need for further studies to clarify the reasons for ANF occurrence in women of childbearing age with RHP and for their longitudinal follow-up.
Objective: to study clinical and imaging characteristics in patients with rheumatoid arthritis (RA) with atlantoaxial joint involvement.Material and methods. A total of 60 patients with RA were examined; mean age was 53.6±12.4 years. Median DAS28-CRP was 5.1 [4.8; 5.3], and median disease duration was 120 [66; 300] months. Extended clinical assessment included evaluation of neurological status, components of neuropathic pain and central sensitization, quality of life, and the degree of functional impairment. Magnetic resonance imaging (MRI) of the craniovertebral junction (CVJ) was performed with assessment of structural changes and measurement of five craniometric parameters to detect displacement of the CII odontoid process.Results and discussion. Clinical signs of cervical spine (C-spine) involvement were present in 91.7% of patients: neck and head pain, varying degrees of activity limitation due to neck pain, and neurological manifestations. MRI revealed CVJ changes in 90% (n=54) of patients: structural abnormalities in 81.7% and displacement of the CII odontoid process in 68.3%. The strongest correlations of structural changes were found with the presence of neck pain, low quality-of-life scores (EQ-5D), high RA activity, peripheral joint erosions on radiographs, arterial hypertension, high body mass index, and the absence of systemic manifestations of the disease. Craniometric abnormalities were associated (p<0.05) with older age, concomitant osteoporosis, poorer quality of life, neuropathic pain, features of the RA course (duration, positivity for anti-cyclic citrullinated peptide antibodies, small joint involvement at onset, functional limitations, fewer systemic manifestations), elevated CRP, more advanced radiographic stage, and glucocorticoid use. Long-term therapy with nonsteroidal anti-inflammatory drugs and biologic agents was associated with less pronounced MRI changes (p<0.05).Conclusion. Based on the study, the risk factors for C-spine involvement in RA patients are neck pain, certain features of the RA course, comorbidity, functional limitations (HAQ), and low quality of life (EQ-5D).
Objective: to study the association of muscle, adipose, and bone tissue markers with abnormal body composition phenotypes in women with rheumatoid arthritis (RA).Material and methods. A total of 163 women (median age 61.0 [52.0; 66.0] years) with a confirmed diagnosis of RA were examined. Dualenergy X-ray absorptiometry was performed; based on the results, the following body composition phenotypes were identified: normal (NP), osteoporotic (OP), sarcopenic (SP), and osteosarcopenic (OSP). Serum levels of myostatin, insulin-like growth factor 1 (IGF-1), leptin (LEP), adiponectin (ADPN), resistin (RES), interleukin 6 (IL-6), irisin, and sclerostin (SOST) were measured.Results and discussion. In patients with OP and OSP, LEP, RES, and SOST levels were significantly lower than in women with NP. In those with OSP, ADPN levels were higher than in patients with NP (p=0.031). IGF-1 levels in NP were significantly higher than in OP, SP, and OSP. Logistic regression showed an association of IGF-1 with OP, SP, and OSP (odds ratio, OR 0.96, 95% confidence interval, CI 0.93–0.99; OR 0.94, 95% CI 0.89–0.99; and OR 0.97, 95% CI 0.95–0.99, respectively; p<0.05). ADPN levels were associated with OP and OSP (OR 1.30, 95% CI 1.02–1.66 and OR 1.23, 95% CI 1.02–1.48, respectively; p<0.05); SOST levels associated with OP and OSP (OR 0.90, 95% CI 0.86–0.95 and OR 0.92, 95% CI 0.87–0.96, respectively; p<0.001); and LEP and RES levels with OP (OR 0.72, 95% CI 0.53–0.99 and OR 0.72, 95% CI 0.58–0.89, respectively; p<0.05).Conclusion. Associations were identified between OP and levels of LEP, ADPN, RES, SOST, and IGF-1; between OSP and levels of ADPN, SOST, and IGF-1; and between SP and IGF-1 only. For IGF-1, the positive predictive value was 100% at the identified cut-off points, which allows it to be considered a predictive marker of abnormal body composition phenotypes in patients with RA.
We present a case of a vessel aneurism rupture with the development of disseminated intravascular coagulation syndrome after SARS-CoV-2 infection in a patient with Marfan syndrome. The appearance of bleeding signs as the earliest symptom, along with microembolic complications, led to multiple organ dysfunction, resulting in death.
Objective: to evaluate the efficacy of the nutraceutical Teraflex Ultra, a combination of glucosamine (G, 1500 mg), chondroitin sulfate (CS, 1000 mg), undenatured type 2 collagen (UC-2, 40 mg), a B-vitamin complex, vitamin C (100 mg), and ginger root extract (300 mg), in patients with the metabolic phenotype of knee osteoarthritis (OA).Material and methods. This prospective randomized study included 29 women aged 40–75 years with a definite diagnosis of knee OA stage I–III according to Kellgren–Lawrence (established in accordance with the ACR classification criteria) and metabolic syndrome, pain on walking ≥40 mm on the visual analog scale (VAS), who provided informed consent. Mean age was 62.4±6.9 years. Median baseline VAS pain was 63 [54; 75] mm. All patients received the nutraceutical Teraflex Ultra orally, 2 capsules twice daily for 6 months; the subsequent 3 months constituted the follow-up period with assessment of the carryover effect. Study duration was 9 months.Results and discussion. The study results demonstrated a statistically significant clinical effect of the nutraceutical in patients with metabolic knee OA during the 6-month treatment course and the subsequent follow-up period. After 1 month of treatment, a significant (p<0.01) reduction in pain on walking in the analyzed knee according to VAS was observed; it persisted throughout the treatment period and 3 months after completion. A reduction of pain to <40 mm on VAS after 1 month of therapy was achieved in 48.3% of patients, after 3 months in 66.7%, and after 6 months in 81.5%. During follow-up, in most patients (77.7%) VAS pain remained <40 mm. Treatment was associated with significant improvement in all WOMAC parameters: decreased pain (baseline 246 [159; 320] mm; 1 month 173.5 [116; 199] mm; 3 months 119 [70; 186] mm; 6 months 84 [48; 157] mm; 9 months 73 [42; 106] mm; p<0.01 for all comparisons vs baseline); decreased stiffness (baseline 101 [63; 129] mm; 1 month 69.5 [36.5; 90] mm; 3 months 46 [23; 85] mm; 6 months 36 [19; 74] mm; 9 months 24 [15; 51] mm; p<0.01 for all comparisons vs baseline); decreased functional limitation (baseline 932 [610; 1085] mm; 1 month 660.5 [459; 767] mm; 3 months 463 [323; 748] mm; 6 months 309 [211; 559] mm; 9 months 265 [189; 440] mm; p<0.01 for all comparisons vs baseline). In all patients during the 6 months of treatment and the followup period, significant improvement in KOOS scores (p<0.01), quality of life according to EQ-5D, and patient global health assessment by VAS (p<0.01) was observed. As a result of therapy, most patients discontinued regular use of nonsteroidal anti-inflammatory drugs (NSAIDs). Conclusion. In patients with the metabolic phenotype of OA, the nutraceutical Teraflex Ultra (a combination of CS, G, UC-2, B vitamins, vitamin C, and ginger root extract) demonstrated a significant clinical effect accompanied by reduced pain, improved joint function and quality of life, and decreased need for NSAIDs.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with marked clinical and immunological heterogeneity, which complicates objective assessment of its activity. The objective of this work was to adapt and translate into Russian the SLE activity index, the Systemic Lupus Erythematosus Disease Activity Score (SLE-DAS). Forward and back translation were performed, the text was reviewed by experts, and a test version was piloted. The final version accounts for clinical and laboratory manifestations of SLE and is convenient for use in routine practice. The Russian-language version of SLE-DAS will help improve objective assessment of disease activity and enhance the quality of patient management.
Erythema nodosum (EN) is the most common type of septal panniculitis without signs of vasculitis. The clinical picture is characterized by painful erythematous nodules predominantly localized on the shins. Although the etiology of EN often remains unknown, the disease is based on a delayed-type hypersensitivity reaction to various antigenic stimuli. Since EN may be the first marker of a serious systemic disorder, ruling out a secondary nature of the disease is of fundamental importance. A wide range of possible etiological factors requires a thorough targeted evaluation of the patient to verify the diagnosis.The authors present a diagnostic algorithm developed by them that will help optimize the initial assessment of patients with EN. Current approaches to the treatment of this condition are discussed.
In recent years, significant progress has been achieved in the study of systemic sclerosis (SSc). The treatment of SSc includes conventional synthetic disease-modifying antirheumatic drugs, biologic agents, including anti-B-cell drugs and interleukin-6 inhibitors, as well as antifibrotic agents. Since the last publication of the EULAR recommendations for the treatment of SSc in 2017, changes have occurred; therefore, an update was prepared in which the treatment of the full spectrum of SSc manifestations is considered more broadly. In the updated document 22 recommendations were formulated, and 8 therapeutic domains were identified. The article presents the EULAR 2023 recommendations for the treatment of SSc, as well as promising directions for scientific research.
