On 30 May, 2024, an expert meeting was held to update the approaches for the treatment of axial spondyloarthritis (axSpA). A new approach to the treatment of axSpA was considered, which consists of depleting autoreactive TRBV9+ T- lymphocytes by introducing a monoclonal antibody – the drug seniprutug. The value of the drug seniprutug in the treatment of the disease was discussed and key aspects for the incorporation of the drug seniprutug into real-world clinical rheumatological practice were agreed.

The article presents the results of the three-year use of netakimab (NTK) in patients with ankylosing spondylitis (AS) as part of the phase III BCD-085-5/ASTERA study. Objective : to evaluate the long-term efficacy and safety of NTK over a three-year period in patients with active AS. Material and methods . BCD-085-5/ASTERA – double-blind, multicenter, randomized phase III clinical trial that enrolled patients with active AS (BASDAI ≥4) and a back pain intensity ≥4 on a numeric rating scale with inefficacy or intolerance of non-steroidal anti-inflammatory drugs or biologic drugs. A total of 228 patients were randomized in a 1:1 ratio and assigned to either the NTK group or the placebo/NTK group. Starting at week 16, patients who did not achieve ASAS20 (20% improvement according to ASAS criteria) received NTK 120 mg once every 2 weeks in an open-label regimen. Patients who achieved ASAS20 response at week 52 in the NTK group and week 68 in the placebo/NTK group continued to receive NTK (120 mg every 2 weeks) until week 156 in the NTK group and until week 172 in the placebo/NTK group. Results and discussion . Over the course of three years of NTK use, most patients experienced a sustained decline in AS activity (according to ASDAS-CRP, BASDAI) with sustained response (ASAS20/40, ASAS5/6) to therapy. Most adverse events reported were mild to moderate. 36.7% of patients had adverse events, which were mainly laboratory abnormalities, blood and lymphatic system abnormalities and infectious complications. Conclusion . The clinical effect of NTK was maintained in most patients with AS over a three-year period, with no significant loss of response. NTK was well tolerated and the safety profile remained favorable.

NiSpAR is a non-interventional, multicenter study whose aim was to describe a cohort of patients with non-radiological axial spondyloarthritis (nr-axSpA) and approaches to its diagnosis in the Russian Federation.Material and methods. The study involved 20 research centers in different regions of the Russian Federation. The work consisted of two phases: retrospective data collection 12 months before enrolment in the study and prospective observation of patients in whom the diagnosis of nr-axSpA was confirmed (104 weeks).The study included 272 patients who met the inclusion and exclusion criteria (Full Analysis Set, FAS). The mean age of the FAS-population was 38.7±11.0 years. The diagnosis of nr-axSpA was confirmed in 159 (58.5 %) of the 272 patients. Of the remaining 113 (41.5%) participants, 57 (50.4%) did not have the information required to confirm the diagnosis, 34 (30.1%) did not have pelvic radiographs, and 22 (19.5%) did not fulfil the ASAS criteria for nr-axSpA.Results and discussion. The mean age of patients with nr-axSpA was 37.6±10.4 years, more than half of them (52.8%) were women. The median disease duration was 36 [12; 80] months. In half of the patients the disease duration was more than 2 years, in more than one third – less than 2 years. The median CRP and ESR values were 5.0 [2.0; 12.0] mg/l and 11.0 [5.0; 18.0] mm/h, respectively. The BASDAI averaged 3.5±2.0 and was >4 in more than half of the cases (64.2%). The mean ASDAS-CRP value reached 2.6±1.1. Only 1 in 5 participants (20.8%) had low axSpA activity, while in 61.1% it was high (44.7%) or very high (16.4%). An inactive state was found in a small number of patients (9.4%). Twenty two (13.8%) patients had treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) in anamnesis, and 21 (13.2%) patients were still taking them.Conclusion. The results of the retrospective phase of the study show that in real-life clinical practice in the Russian Federation there is a continued positive trend towards improving the diagnosis of nr-axSpA. The median duration of the disease at the time of enrolment in the study was 3 years. The frequency of use of magnetic resonance imaging has increased by more than 1.8 times. At the same time, practitioners still have difficulties in establishing the diagnosis of nr-axSpA and a shortage of bDMARDs for treatment of these patients.

The aim – to evaluate the clinical effectiveness, safety, pharmacokinetics, pharmacodynamics, and immunogenicity of seniprutug (BCD-180) in patients with radiographic active axial spondyloarthritis (r-axSpA, or ankylosing spondylitis).Subjects and methods. 260 patients with active r-axSpA and inadequate response to nonsteroidal anti-inflammatory drugs (NSAIDs) were randomized into three groups: seniprutug (BCD-180) at doses of 5 mg/kg or 7 mg/kg, or placebo. BCD-180 was administered on weeks 0–12–36. Patients in the placebo group were switched to BCD-180 at a dose of 5 mg/kg at week 24 and continued therapy at week 36. The primary endpoint was the proportion of patients achieving 40% improvement by Assessment in Spondyloarthritis International Society scale (ASAS40) at week 24. Secondary endpoints were proportion achieving ASAS20/40, improvement of 5 out of 6 criteria of ASAS (ASAS5/6), ASAS partial remission, clinically important improvement in ASDAS-CRP (Ankylosing Spondylitis Disease Activity Score with C-reactive protein) (ASDAS-CII) and major improvement in ASDAS-CRP (ASDAS-MI). The dynamics of the disease activity status according to ASDAS-CRP, the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and BASFI (Bath Ankylosing Spondylitis Functional Index) indices, as well as the dynamics of laboratory markers (C-reactive protein anderythrocyte sedimentation rate (ESR)) were analyzed. Safety was assessed by the frequency and profile of adverse events (AEs) and adverse reactions (ARs).Results. The proportion of patients achieving ASAS40 at week 24 with seniprutug (BCD-180) at the dose of 7 mg/kg and 5 mg/kg was 51.4% and 40.8%, respectively, compared with 24% in the placebo group (p=0.0012 and p=0.0417, respectively). Analysis of secondary endpoints showed that in patients with r-axSpA, BCD-180 at both study doses was significantly superior to placebo at week 24 in the following measures: decrease in the proportion of subjects with very high disease activity (ASDAS-CRP>3.5) achieving ASDAS-CII, ASAS20, ASAS5/6. A statistically significant decrease in the ASDAS-CRP, BASDAI, BASFI indices, as well as the concentration of CRP and ESR were demonstrated. Tolerability of seniprutug therapy was assessed as acceptable. Infusion reactions were the most common observed adverse events, the vast majority of which were mild to moderate in severity according to CTCAE 5.0 (Common Terminology Criteria for Adverse Events) and developed predominantly during the first administration. The proportion of patients with binding antibodies was 5.1%. However, no neutralizing antibodies were detected.Conclusion. Seniprutug (BCD-180) demonstrated superiority over placebo in clinical efficacy with a favorable safety profile and low immunogenicity as a treatment of r-axSpA.

The purpose — to evaluate the nature of pain syndrome in patients with ankylosing spondylitis (AS) in correlation with the course of the disease. Material and methods. 76 patients with a verified diagnosis of AS were examined. Men accounted for 60.5% of the patients, women — 39.5%. The mean age in the studied group of patients was 42 [34.25; 58.75] years. Disease activity was assessed by ASDAS-CRP, median 4.05 [2.91; 4.7]. The mean disease duration was 138 [96; 261] months. To assess the multicomponent of chronic pain, the following were used: neuropathic pain (NP) questionnaire — Pain Detect, Central Sensitisation Inventory scale to assess the relationship of pain with central sensitization (CS), EQ-5D and SF-36 questionnaires to assess the quality of life. Results. In the studied cohort of patients, only 10.5% had isolated inflammatory pain, all others had mixed pain. Three-component pain occurred in 52.8% of cases. Patients with mixed pain were older in age, had higher disease activity according to ASDAS-CRP, had radiological stage 3–4 and reduced quality of life according to EQ-5D-3L and SF-36 questionnaire. NP in patients with AS was significantly dependent on the presence and severity of peripheral arthritis (r = 0.468, p < 0.001), the level of ESR (r = 0.552, p < 0.001) and circulating immune complexes (r = 0.464, p = 0,005). CS was associated with greater pain intensity by VAS (r = 0.610, p < 0.001), was dependent on inflammatory markers — CRP (r = 0.451, p = 0.004), influenced quality of life by EQ-5D (r = — 0.681, p < 0.001) and SF-36 (physical comp r = -0.579, p < 0.001, mental comp r = -0.587, p < 0.001) questionnaires. Conclusions. In 89.5% of the studied patients with AS, the chronic pain syndrome was mixed in nature, with CS predominating over NP. Patients with AS and presence of several types of pain had higher clinical and laboratory activity of the disease and X-ray stage, peripheral arthritis was more frequent.

Purpose of the study. To evaluate the character of pain syndrome in patients with rheumatoid arthritis in correlation with the course of the disease and comorbid pathology. Material and methods. Sixty-six patients with a verified diagnosis of RA were examined. Of them 84.9% were women (n=56) and 15.1% men (n=10). The median age was 59 [52; 63] years. Disease activity was assessed by DAS28-CRP, with a median of 5.2 [4.54; 6.0]. Patients with moderate (31.8%) and high activity (57.5%) predominated. Disease duration averaged Me 156 [93; 246] months. Seropositive RA was suffered by 89.3% of patients. The distribution by radiological stage was as follows: 2 radiological stage – 36.3% (n=24), 3 radiological stage – 30.3% (n=20), 4 radiological stage – 33.4% (n=22). Baseline anti-inflammatory therapy was taken by 84.8% of patients (n=56), genetically engineered biological drugs were received by 28.7% (n=16). To assess the multicomponent nature of pain syndrome, the following were used: Pain Detect questionnaire — to verify neuropathic pain (NP), CSI questionnaire — to verify central sensitisation (CS). The EQ-5D-3L questionnaire was used to assess quality of life, and the Charlson index was used to assess comorbid pathology. Structural changes were assessed by modified Sharpe method on hand and foot radiographs, synovium vascularisation was assessed by joint ultrasound. Results. 84.8% of patients had pain syndrome of mixed nature. NP correlated with pain intensity by VAS (rSp=0.458, p<0.001), DAS28-CRP (rSp=0.509, p<0.001), number of peripheral arthritis (rSp=0, 414, p<0.001), number of comorbidities (rSp=0.337, p=0.006), Charlson index (rSp=0.323, p=0.009), EQ-5D-3L (rSp= –0.268, p=0.031). CS–with VAS pain intensity (rSp=0.250, p=0.045), DAS28-CRP (rSp=0.251, p=0.044), number of painful joints (rSp=0.353, p=0.004), number of comorbidities (rSp=0.368, p=0.003), BMI (rSp=0.266, p=0.032), systolic blood pressure level (rSp=0.403, p<0.001), number of erosions on hand and foot radiographs (rSp= –0.299, p=0.016), EQ-5D-3L (rCp= –0.408, p<0.001). Patients with the presence of synovial vascularization by ultrasound had three-component pain in more than half of cases, and the combination of inflammatory pain and CS did not occur in them. Conclusions. 84.8% of patients had multicomponent pain, with pain associated only with clinical parameters of disease activity. Associated pathology and local chronic inflammation in the joint potentiate the development of other types of pain and have a mutual negative influence.

The purpose — to identify the relationship of clinical characteristics with MRI-verified atlantoaxial changes in patients with rheumatoid arthritis. Material and methods. 30 patients with rheumatoid arthritis were examined, mean age was 53.3 ± 13.51 years. Mean activity score (DAS28 (CRP)) was 5.24 ± 0.62. Median disease duration was 137 [12; 660] months. Extended clinical examination included: assessment of neurological status, presence of neuropathic pain components and central sensitization, assessment of quality of life, and degree of functional impairment. MRI of the craniovertebral junction with measurement of 5 craniometric parameters was performed for the dens axis translocation. Results. 60% of patients had complaints of pain in the craniovertebral junction: in the neck — 76.7%, in the occipital region — 33.3%, with a mean VAS 6.34 ± 1.84 mm. The mean HAQ value was 1.64 ± 0.61, EQ-5D 0.45 ± 0.51; SF-36 mental component was 38.23 ± 9.35; physical component was 31.44 ± 8.98. Neurological disorders were detected in 53.3% at objective examination: motor disorders in 26.7%, changes in superficial sensitivity in 30%, parasthesias in 40%. Various MRI changes were noted in 96.7% of patients. We found correlations of atlantoaxial changes with ESR (rSp=0.470; p=0.018), CRP (rSp = -0.935; p = 0.006), number of painful joints (rSp = 0.503; p = 0.009), patients’ age (rSp = 0.461; p = 0.018), body mass index (rSp = -0.447; p = 0.022), number of comorbidities (rCp = -0.541; p = 0.005), quality of life according to EQ-5D (rCp = -0.400; p = 0.043), presence of central sensitization according to CSI questionnaire (rCp = -0.601; p = 0.001), and with psychological component of SF-36 questionnaire (rCp = -0.492; p = 0.011). Conclusion. Patients with RA have various MRI changes of the craniovertebral junction, both in the form of asymptomatic initial manifestations of translocation and with signs of neurological deficit due to spinal cord compression. Changes in the atlantoaxial region according to MRI correlated with the level of inflammatory markers, peripheral arthritis, comorbid pathology, patient’s age, and quality of life.

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.

Ankle capsular ligamentous apparatus damage is one of the most common problems. Ankle injuries account for one-fifth of all lower extremity sports injuries. More than 81 % of acute ankle injuries are treated conservatively, with the rate of unsatisfactory results after this treatment ranging from 2 to 36.9 %. Objective: to evaluate the efficacy and safety of the combined use of aceclofenac (Airtal) and tolperisone (Mydocalm Long) in patients with acute ankle ligament injuries. Material and methods. Sixty patients aged 18 to 65 years with acute ankle ligament injury of grade II according to Kannus and Renstrom, with pain intensity in the joint on a visual analogue scale (VAS) ≥ 50 mm, who had no contraindications for the use of these drugs, participated in the study. Patients in the main group (n = 30) received aceclofenac 100 mg in powder form 2 times daily and tolperisone 450 mg in tablets once daily for 14 days. Patients in the comparison group (n = 30) received only aceclofenac 100 mg in powder form 2 times daily for 14 days. The efficacy of therapy was assessed by pain dynamics according to VAS and functional abilities according to the Foot and Ankle Ability Measure (FAAM) questionnaire, which included the Activities of Daily Living (ADL) subscale and the Sports subscale. To assess safety, laboratory tests were performed at visits 1 and 4, and adverse events (AEs) were assessed at visits 2, 3, and 4. Results and discussion. Combined use of aceclofenac and tolperisone in patients with acute ankle ligament injuries resulted in more clinically significant pain reduction and improvement in functional indicators than aceclofenac monotherapy. In the combination therapy group, after completion of treatment on day 15, the severity of pain decreased by 94.8%, the increase in the score on the ADL scale was 62.9 % and on the Sports scale – 70.4 %. In the monotherapy group, pain intensity decreased by 85.1 %, the increase in the score on the ADL scale reached 40.7% and onthe Sports scale – 43.4 %. Throughout the study period, the medications were well tolerated, and no AEs were recorded. Conclusion. The combined use of aceclofenac and tolperisone in patients with acute ankle ligament damage leads to a reduction in pain intensity in a short time, significantly improves indicators of functional activity, promotes a faster return to sports activities, and at the same time has a favourable safety profile.

The article contains the data obtained during the 156-week follow-up of patients with ankylosing spondylitis (AS) in the ASTERA phase III study.Objective: to evaluate the effect impact of netakimab (NTK) on quality of life (QoL), back pain and work capacity in patients with active AS.Material and methods. The study enrolled 228 patients with active AS who were randomized 1:1 to receive NTK 120 mg or placebo. At week 52, patients in Group 1 (NTK) who achieved ASAS20 continued therapy (NTK at a dose of 120 mg once every 2 weeks) until week 156. Patients in Group 2 (placebo/NTK) received the study drug at a dose of 120 mg subcutaneously every 2 weeks from week 20 until week 68, after which the efficacy of therapy was determined (by achieving an ASAS20 response). Patients who achieved ASAS20 received treatment (NTK at a dose of 120 mg once every 2 weeks) until week 172.Results and discussion. Under NTK therapy, a significant improvement in QoL was observed in the assessment of the physical and psychological components of the SF-36 questionnaire, which was maintained during the three years of therapy: increase in indicator by 12.68±9.92; 13.27±10.14; 12.92±10.03; 14.10±10.35; 14.76±9.77 and 6.10±11.59; 5.50±11.82; 6.32±11.01; 5.87±11.45; 5.25±11.98 points at week 52, 76, 104, 128 and 156, respectively. During the extended therapy period, a reduction in the proportion of working hours missed for health reasons, an improvement in work capacity and work efficiency and an increase in daily activity were observed. Back pain (BASDAI question 2) and nocturnal back pain decreased steadily during the entire follow-up period compared to the screening values.Conclusion. NTK is an effective therapy for active AS that improves QoL scores, significantly reduces pain intensity and improves work productivity.

At the meeting of the Expert Council on May 20, the safety of treatment for patients with osteoarthritis (OA), the most common form of joint disease, was discussed. The first step in the treatment of OA should be the administration of symptomatic delayed-acting agents (SYSADOA) and nonsteroidal anti-inflammatory drugs (NSAIDs). However, given the current understanding of the pathogenesis of inflammation, as well as the fact that it is an active process involving multiple proinflammatory and pro-resolving mediators, it is reasonable to limit the cyclooxygenase-2 suppressive treatment and to include medications with multipurpose effects that contribute to the resolution of inflammation, in particular Zeel® T and Traumeel® S. Traumeel® S affects all stages of inflammation, mostly on the pro-resolving mediators synthesis, and Zeel® T affects chondrogenesis, inflammation, metabolic processes in cartilage tissue and prevents angiogenesis. It was found that it is advisable to use Traumeel® S when it is not possible to prescribe systemic NSAIDs for pain relief. The combination of the proven therapeutic efficacy of Zeel® T and Traumeel® S with a minimal number of adverse events and the absence of interactions with other drugs allows them to be used as an independent treatment regimen for OA.

The purpose — to assess the early imaging changes in the atlantoaxial area and to compare them with clinical and laboratory characteristics in patients with ankylosing spondylitis (AS). Material and methods. 20 patients with AS were examined, the average age is 44.2 ± 12.66 y. o. Activity (ASDAS(CRP)): very high — 85%, high — 5%, low — 10%. X-ray stage of sacroiliitis: 2 — 60%, 3 — 15%, 4 — 25%. Functional deficiency (FD): 3 — 55%, 2 — 20%, 1 — 25%. The duration of illness was 176 [2; 360] months. The extended clinical examination included: assessment of neurological status, presence of components of neuropathic pain (NP) and central sensitization (CS), assessment of quality of life, degree of functional disorders. Magnetic resonance imaging (MRI) of the craniovertebral junction was performed with the measurement of 5 craniometric parameters (CMP) for the presence of translocation of the dens axis. Results. Neck pain syndrome — 75%: inflammatory — 95%, non-inflammatory — 80% (NP — 65%, CS — 50%). VAS: 5.75 ± 2.09. FD: BASMI — 3.86 [2; 7], BASFI — 4,84 [0,7; 8,7]. 75% — limitation of neck rotation, 65% — increase in the distance of the trestle-wall. CMP: 100% — decrease in the retroflex angle, 20% — increase in the anterior atlantodental index, 15% — translocation relative to the Chamberlain line, 10% increase in pB-C2, 5% — decrease in the posterior atlantodental index. A correlation was revealed between the CMP with the X-ray stage (rSp = 0.629; p = 0.021), BASMI (rSp = 0.575; p = 0.04) and the psychological component SF-36 (rSp = 0.570; p = 0.042). The angle of retroflexion with the duration of the disease (rSp = -0.580; p = 0.038), CRP (rSp = 0.624; p = 0.023). Conclusions. All patients with AS had pathological MRI changes in the form of initial manifestations of translocation of the dens, which had nonspecific clinical manifestations. Changes in craniovertebral transition to MRI did not correlate with disease activity (ASDAS (CRP)), but were associated with the level of CRP, duration of the disease, X-ray stage of sacroiliitis and functional indices (BASMI).

Gonarthrosis is a chronic degenerative-inflammatory disease of the knee joint in which all components of the joint are affected. In current clinical guidelines for the treatment of osteoarthritis of the knee, the first step in therapy is the prescription of symptom-modifying drugs with delayed action. One of the most well-studied and effective of these drugs is chondroitin sulfate. A promising remedy for the treatment of gonarthrosis is intra-articular injections, primarily of high-molecular-weight hyaluronic acid preparations, which have proven effective in clinical practice. Their use at an early stage of the disease can contribute to a more complete implementation of the potential of these drugs. The purpose — to study the effect of the combined use of chondroitin sulfate and the Revisk synovial fluid prosthesis on reducing the severity of pain and improving functionality in patients with knee osteoarthritis. Material and methods. 60 patients with stage I–II gonarthrosis according to Kellgren-Lawrence, with intensity of pain according to VAS ≥ 50 mm, and with algofunctional Lequesne index ≥ 5 points were divided into three comparable groups of 20 people. All patients had no contraindications for intramuscular injection of chondroitin sulfate and intraarticular injection of hyaluronic acids, there were no anamnestic indications of their intolerance. In the comparison groups, patients received monotherapy with chondroitin sulfate intramuscularly (group 1) and hyaluronic acid 2.2% (group 2), in the main group, patients received combined therapy with chondroitin sulfate intramuscularly and Revisk intraarticular hyaluronic acid. The effectiveness of therapy was assessed by the dynamics of pain according to the VAS, the algofunctional index of Lequesne, the WOMAC index, and the EQ-5D questionnaire. Results. With the combined use of chondroitin sulfate and the Revisk synovial fluid prosthesis, a clinically more significant decrease in pain syndrome and an improvement in functional parameters were revealed than with monotherapy with chondroitin sulfate, and than with a single administration of hyaluronic acid preparations. At the end of the course of therapy, the severity of the pain syndrome decreased by 75.57%. Conclusions. The data obtained allow the use of both drugs in the complex therapy of knee osteoarthritis in patients with comorbidity. The combined use of chondroitin sulfate and Revisk synovial fluid prosthesis in patients with osteoarthritis of the knee joints reduces the severity of pain, improves functional activity, improves the quality of life of patients.

Patients with ANCA-associated vasculitis (AAV) cause extreme alertness during the coronavirus disease 2019 (COVID-19) pandemic, associated with many factors: the initial damage to the respiratory system (upper respiratory tract, lungs) and kidneys, immunosuppressive treatments, difficult prognosis of COVID-19 with the risk of AAV exacerbation. We present a clinical case of а moderate COVID-19 in a patient with granulomatosis with polyangiitis, who received anti-B cell therapy with rituximab (RTX) for a long time. Coronavirus pneumonia developed one year after RTX, while B-lymphocyte depletion persisted. In order to achieve an adequate antiviral immune response and prevent hyperinflammation, treatment was carried out with antiviral drugs, anticoagulants, convalescent plasma, human normal immunoglobulin, and interleukin-6 antagonist tocilizumab. Possible predictors of severe COVID-19 in patients with AAV are discussed.

Seronegative spondyloarthritis (SpA) (psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA)), inflammatory bowel disease (IBD) and psoriasis form a group of immunoinflammatory diseases (IIDs). The increased risk of developing IBD in patients with IIDs is known and, on the contrary, the risk of skeletal-muscle IIDs in patients with IBD was demonstrated. This indicates the necessity of early diagnosis of IBD in patients with SpA. In connection with this, a screening tool «Universal questionnaire for identifying signs of immunoinflammatory diseases» was developed and put into practice. The article shows the results of the «Universal questionnaire for IIDs» use in rheumatology practice by 140 patients with SpA. It was found that 17.2% patients with PsA and 20.8% with AxSpA required further exclusion of IBD. The need to exclude IBD was equally frequent in patients with PsA and AxSpA. Clinical and laboratory parameters in groups with the alleged IBD did not significantly differ from those in other patients, which confirms the need to introduce the «Universal questionnaire» into the practice for the purpose of early diagnosis of combined IIDs.

Introduction. Biological disease modifying drugs (bDMARD) in the treatment of ankylosing spondylitis (AS) have shown good results with the achievement and long-term preservation of remission. There is a discussion about the withdrawal of drugs without loss of effect in order to reduce the economic burden, drug load, adverse events, the possibility of interrupting therapy during surgical treatment. Aim. To evaluate the potential for sustaining the therapeutic effect of netakimab (NTK) after its discontinuation in patients with AS who have achieved remission. Materials and methods. A cohort of 11 patients diagnosed with ankylosing spondylitis (AS) who had achieved remission was included in this study. The patients were closely observed for 52 weeks after discontinuing NTK treatment. AS exacerbations, pain intensity, disease activity scores (BASDAI, ASDAS), enthesitis evaluations (MASES), functional impairments (BASMI and BASFI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were documented, as well as radiographic and MRI assessments of the sacroiliac joints and spine were performed. Results. Out of the 11 patients, 5 (45.5%) experienced AS exacerbations within the 12-month observation period. Patients who developed flare-ups had higher baseline levels of BASDAI, ASDAS, BASMI, and CRP at the time of NTK discontinuation. They also had a longer disease duration and were older compared to patients without relapse (p < 0.05). The presence of flare-ups was significantly associated (p < 0.05) with a history of peripheral arthritis, previous treatment with IFN-alpha, and the number of comorbidities. By week 52 of the observation period, patients demonstrated a deterioration in both activity and functional limitations (p < 0.05). Elevated ASDAS-CRP levels were found to be correlated (p < 0.05) with higher radiographic stages of sacroiliitis, the presence of syndesmophytes, functional limitations based on BASMI at the time of drug discontinuation, and the absence of continuous NSAID use. Significant prolongation of remission was associated with a substantial decline in ASDAS-CRP under NTK treatment (rSp = 0.996; p < 0.05), especially among younger patients (rSp = 0.607; p < 0.05). Conclusions. Approximately half of the patients who discontinued NTK therapy after achieving clinical and laboratory remission were able to sustain it. Maintenance of remission for 1 year was more prevalent in younger patients with shorter duration of AS, achieving inactive disease status based on ASDAS-CRP, fewer functional limitations, absence of peripheral arthritis, and comorbidities. Nevertheless, regular patient monitoring is necessary to promptly identify disease recurrence.

The article reports the problems of sacroiliitis and spondylitis in patients with ankylosing spondylitis and psoriatic arthritis. Based on the concept of primary involvement the sacroiliac joint in inflammation, they are most often is the object of investigations. But inflammatory changes also affect the spine that’s called the spondylitis. Due to the widespread introduction of medical imaging, scientists know the various variants of axial characteristic in inflammatory spondylopathies: angular (Romanus lesion) and non-angular spondylitis (Andersson lesion, osteitis of the arch, inflammation of the facet joints). However, generally accepted criteria for assessing inflammation of the spinal column in these pathologies have not been developed. Also, frequency of these lesions is not researched. Further study of various variants of spondylitis in ankylosing spondylitis and psoriatic arthritis is necessary, since these data will significantly contribute to the understanding of axial involvement in inflammatory spondylopathies.

The article presents a clinical case of a 27-year-old woman with infectious endocarditis in vasculitis associated with antineutrophil cytoplasmic antibodies. Difficulties in the management of the patient are described, consisting in verifying the nature of changes in the heart (vegetation), as well as in determining the treatment tactics. Changes in the heart were regarded as infectious endocarditis. Adequate antibacterial therapy was carried out with a positive clinical and laboratory effect, with a significant decrease in vegetations on the valves, a decrease in the size of the formation in the aorta sinus, and a decrease in aortic regurgitation. The therapy of infectious endocarditis in granulomatosis with polyangiitis is difficult due to the need for a correct combination of adequate antibacterial therapy of infectious endocarditis and high doses of glucocorticosteroids and immunosuppressive drugs for autoimmune disease.