Aim. To study the association of serum nesfatin 1 (NF-1) levels with body mass index (BMI), body composition and rheumatic cachexia (RC). Design. Cross-sectional comparative study. Materials and methods. 110 patients with rheumatoid arthritis (RA) and 60 healthy controls were enrolled in our study. Standard clinical and laboratory examination was performed. NF-1 levels were determined with enzyme-linked immunosorbent assay. Each person undergone dual-energy X-ray absorptiometry with Total Body program. Results. Serum NF-1 levels were higher in patients with RA, compared with healthy controls (50.49 ± 34.05 vs 31.61 ± 3.17 ng/ml, t = 4.28; p < 0.0001). RC was determined in 30 patients. In healthy controls, the median level of NF-1 was higher in overweight patients than with normal BMI of class 1 obesity (H = 6.0; p = 0.049). NF-1 in patients with RA correlated with lean mass in legs (separately for the left one), left half of the body, trunk and android region. Median levels of NF-1 in patients were comparable in patients with or without RC. Conclusion. Despite we observed association between serum NF-1 levels and lean tissue mass, this neuroendocrine peptide can’t be used as a marker for RC (Z = 1.45; p = 0.147). Additional studies should be performed to clarify the mechanism of association of NF-1 with lean tissue mass, which would likely contribute to the development of a new approach to controlling this indicator. Keywords: nesfatin 1, rheumatoid arthritis, body composition, body mass index, rheumatic cachexia.

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).

Long-term therapy with non-steroidal anti-inflammatory drugs (NSAIDs) may be appropriate in patients with osteoarthritis (OA) who have chronic pain.The aim – to evaluate the efficacy and safety of nimesulide in the 3-month treatment of osteoarthritis.Material and methods. The study group consisted of 282 patients, 79.4% women (age 54.5±8.9 years), with knee OA (50.0%), hip OA (12.4%) and multi-joint OA (37.6%). All patients had comorbidity, including 94.3% arterial hypertension (AH) and 22.7% type 2 diabetes mellitus. All patients had moderate to severe pain (≥4 on a numerical rating scale (NRS 0–10)) for at least 3 months. All patients were prescribed nimesulide 100 mg twice daily. If pain decreased, a reduction in the dose of nimesulide to 100 mg daily or a switch to an on-demand regimen was suggested.Results. After 1 and 3 months of therapy, 82.3% and 49.3% of patients continued to take nimesulide regularly, and 17.4% and 39.7% continued to take it ‘on demand’. 11,0% of patients stopped taking the drug by 3 months, mainly because of pain control or significant pain reduction. In 1 and 3 months all patients showed significant improvement in the severity of the main symptoms of OA. Thus, pain on movement (NRS) decreased from 6.7 to 4.3 and 2.0; WOMAC pain from 11.3 to 7.3 and 3.9; impaired function (NRS) from 5.4 to 3.4 and 1.6; WOMAC function from 38.9 to 25.4 and 14.7 (for all parameters p<0.001). For all parameters, more than 75% of patients showed improvement ≥50% from baseline. 83% of patients reported an acceptable symptom state (PASS). After 3 months, no serious adverse events (AEs) were noted. Dyspepsia was noted in 3.9%, stool disturbance and gastroesophageal reflux disease in 3.2% each, AH in 4.6%, and hyperglycaemia in 1.1%. No withdrawal of nimesulide due to HP was noted.Conclusion. Nimesulide is effective and relatively safe in the long-term treatment of patients with OA and chronic pain.

Introduction . The development of osteoporosis (OP) increases healthcare costs and often leads to disability of patients. In this regard, the search for ways to improve the effectiveness of OP treatment is very relevant. Today, there is a wide range of drugs for the effective correction of bone metabolism. However, low patient compliance in real clinical practice significantly reduces the effectiveness of therapy. Aim. To study the effect of patient compliance on the effectiveness of Zoledronic acid and Denosumab in OP in real clinical practice. Materials and methods . Study design: a retrospective analysis of outpatient records of 300 patients with OP, who were prescribed Zoledronic acid or Denosumab in 2019, with a prospective analysis of adherence to therapy for 3 years. Results. It was revealed that 12% of patients did not start pathogenetic therapy for OP (control group). 88% (264 patients) started pathogenetic therapy: of these, 22.33% (67 patients) preferred therapy with Denosumab; 65.67% (197 patients) – Zoledronic acid. After 1 year, therapy with Denosumab 19.4%, Zoledronic acid – 19.29% was discontinued. More than 1 month late with the next injection of the drug: Denosumab – 25.37%, Zoledronic acid – 16.24% of patients. Only 55.22% who received Denosumab and 64.47% who received Zoledronic acid fully complied with the recommendations. Most often, a violation of the schedule of drug administration was observed in patients over 75 years of age, alone, with impaired cognitive status. Discontinuation of therapy with Denosumab or violation of the schedule of its administration led to an increase in the level of bone resorption (C-telopeptide type I collagen (CTX-1)). During therapy with Zoledronic acid, there was no increase in CTX-1. In addition, the cost of course treatment with Zoledronic acid is 2–3 times less than with Denosumab. Conclusion. In real clinical practice, zoledronic acid has clinical and pharmacoeconomic advantages, especially in patients with expected low adherence to OP therapy.

Introduction . Rheumatoid arthritis (RA) is a systemic autoimmune disease as well as a typical inflammatory process. Chemerin is a fat tissue cytokine, which specific receptors were discovered on the surface of the innate immune cells. It is of interest to study the association of chemerin with the complications and comorbidity in RA. Aim . To study the association between serum chemerin levels with complications and comorbidity in rheumatoid arthritis. Materials and methods . 88 women with RA were enrolled in our study. ll patients undergone standard clinical and laboratory examination. Serum chemerin, high-sensitive C-reactive protein (hsCRP), anti-citrullinated protein antibodies, insulin and C-peptide levels were determined using ELISA. X-ray absorptiometry was performed. Statistical analysis was performed using conventional methods with a software package Statistica 10.0. Results . Median chemerin concentration was 463.5 [366–576.5] ng/ml. Chemerin concentration correlated with the age (ρ = 0.232; р = 0.030), weight (ρ = 0.254; р = 0.017) and body mass index (BMI) (ρ = 0.212; р = 0.047), but wasn’t associated with the RA classification criteria. Positive correlation between chemerin concentration and number of painful joints (NPJ) (ρ = 0.213; р = 0.046) and hsCRP (ρ = 0.273; р = 0.010) was observed. Patients with type 2 diabetes mellitus (DM2) had higher chemerin concentration (598.0 ng/ml vs 479.5 ng/ml, Z = -2.68; p = 0.007) and patients with cholecystectomy in anamesis had lower (359.0 ng/ml vs 479.0 ng/ml, Z = 2.02; p = 0.043). Chemerin concentration correlated with systolic and diastolic blood pressure (BP) (ρ = -0.41; р < 0.001 and ρ = -0.27; р = 0.028, respectively). Conclusions . Chemerin concentration in women with RA correlates with age, weight, BMI, NPJ and hsCRP. Chemerin concentration in patients with comorbid DM2 was higher and in patients comorbid with cholecystectomy in anamnesis was lower. Chemerin concentration correlates negatively with a systolic and diastolic BP.

According to the European guidelines for osteoporosis, the same FRAX intervention threshold is suggested for men as for women. At the same time, in the Russian Federation, according to research data, an extremely low proportion of identified men who are subject to the initiation of osteoporosis therapy. The female intervention threshold identifies only 1.1 to 4% of men for treatment. Aim – to develop and evaluate various options for the intervention threshold using the FRAX calculator for men in the Russian Federation and adopt the most acceptable intervention threshold by consensus. Material and methods . Delphi voting was conducted among 18 Russian experts who have publications and personal reports about their experience with the FRAX calculator. For discussion, 5 intervention threshold options with the corresponding rationale based on the literature reference were presented, as well as the proportion of men of different ages to be initiated in each of the options (based on several Russian population-based studies). Anonymous voting was carried out using the Delphi method with questionnaire placed in the Google form. It was proposed to evaluate all options for intervention thresholds on a 9-point Likert scale. Consensus was considered reached if the intervention threshold reached a Likert score of 7 or more points in 80% or more of the experts. The rating of each intervention threshold option was expressed as mean and standard deviations. Results . In the first round of voting, the maximum rating and percentage of agreement is reached for the 9% fixed interference threshold option based on the FRAX calculation. The rating was 7.72±1.6 points, the percentage of experts’ agreement was 88.9%. A fixed threshold of 9% determined 13–19.5% of men aged 50 years and older to be treated for osteoporosis, while their proportion increased to 26–38% at the age of 85 years and older. Conclusion . The consensus of experts of the Russian association on osteoporosis suggests initiating treatment of osteoporosis in Russian men with a 10-year probability of major osteoporotic fractures according to FRAX of 9% or higher.

Introduction. Osteoarthritis (OA) is a chronic progressive disease of the joints, accompanied with pain, which limits the mobility of patients. Functional limitations, chronic pain syndrome worsen the quality of life (QoL) in OA of the joints of the lower extremities. QoL significantly depends on the effectiveness and methods of pain treatment, correction of functional disorders. Aim. Evaluation of the dynamics of QoL in patients with gonarthrosis treated with a high-tech synovial fluid prosthesis – sodium hyaluronate, domestic production. Materials and methods . The study group consisted of 50 patients who received intra-articular (IA) injections of domestically produced sodium hyaluronate (OOO Ingal, Russia). Comparison group – 30 patients treated with 2 ml of symptomatic drugs of delayed action (SYSADOA) (bioactive concentrate of small marine fish) administrated IA No. 5. Control group – 100 patients treated with a 1 ml of SYSADOA drugs administrated intramuscularly (IM) No. 20. Study program: 12 months, 6 visits with prospective monitoring of the quality of life of patients according to SF-36 compared with baseline data. Results. At the time of inclusion, patients had a similar level of physical and mental health components, which did not differ statistically significantly (p = 0.369 and p = 0.089). The study group demonstrated the best dynamics of the physical and mental components of health. The therapy was effective in all groups: most patients showed a statistically significant decrease in pain syndrome, an increase in QoL. The groups differed significantly in the speed of achieving the effect of pain relief, the severity of pain reduction and the duration of the effect of treatment. Conclusions. The spectrum of side effects of non-steroidal anti-inflammatory drugs (NSAIDs) does not allow their use for pain relief indefinitely. SYSADOAs become less effective in the progression of OA than in the early stages of the disease. The positive clinical effect of intra-articular injection of sodium hyaluronate solutions occurs faster and lasts longer than when using SYSADOA.

Introduction. Scientific discussions about ways to improve the effectiveness and safety of osteoarthritis (OA) therapy do not stop. The article discusses the most controversial issues of the problem and presents the results of a study on the use of sodium hyaluronate in gonarthrosis. Aim. To compare the clinical efficacy, tolerability and safety of the use of synovial fluid substitute of domestic manufacture and symptomatic slow-acting drugs (SYSADOA) in patients with gonarthrosis. Study design. Prospective, comparative, randomized, single center study. The duration of the study was 12 months. Materials and methods. The study included 180 patients with gonarthrosis, randomized into three groups. Study group: 50 patients treated with Ripart® sodium hyaluronate solution intra-articularly. Comparison group: 30 patients treated with SYSADOA, intraarticular. Control group: 100 patients treated with SYSADOA intramuscularly. Results. The most rapid and pronounced decrease in the VAS index was obtained during sodium hyaluronate therapy: by 31% at the 1st week, by 48% by the end of the 2nd week, with a maximum decrease by 49.1% by the 3rd month (p < 0.001). After 12 months, a lower level of the VAS index was observed: 32% lower than before the start of therapy (t = 47.23; p < 0.001). Comparable results were observed in this group in terms of the dynamics of the AUSCAN/WOMAC index. The effectiveness of therapy in the comparison and control groups was lower (p < 0.05). In addition, the use of sodium hyaluronate provided a significant reduction in the need for taking NSAIDs: 20 patients completely stopped taking NSAIDs (40%), 25 (50%) – they began to take NSAIDs less often or reduced the dose of drugs by 2 times, after 12 months they continued taking NSAIDs only 20% of patients in this group (p < 0.05). Сonclusions. Thus, Ripart® demonstrated high efficiency in reducing pain, contributed to a significant reduction in the need for NSAIDs in patients with gonarthrosis, and has a good safety profile.