Background. It is assumed that chronic immune-inflammatory rheumatic disease may be a factor increasing the likelihood of developing hypogonadism syndrome, and vice versa – the presence of uncompensated testosterone deficiency may predispose to a higher risk of developing or a more severe course of immune-inflammatory rheumatic disease. Aim. To study the frequency of hypogonadism in men with systemic sclerosis (SSc) and idiopathic inflammatory myopathy (IIM) and its associations with clinical manifestations of SSc and IIM. Materials and methods. A total of 65 patients were included in the one-stage continuous study, including 39 with SSc and 26 with IIM, who were undergoing inpatient treatment at Nasonova Research Institute of Rheumatology. The patients underwent determination of the level of total testosterone with subsequent division into subgroups with normal (12 nmol/l) and reduced levels. An intergroup comparison was performed using the main indicators used in clinical rheumatology practice to assess the clinical and demographic characteristics of SSc and IIM. A correlation analysis was performed between the level of total testosterone and some clinical and laboratory indicators. Results. The frequency of detected testosterone deficiency in SSc was 23.1%, and in IIM – also 23.1%. Patients with hypogonadism and SSc, compared with the group with normal testosterone levels, were characterized by a higher body mass index – BMI (27.0 [25.8; 29.8] kg/m2 vs 23.5 [22.0; 26.1] kg/m2; p=0.033), were more often obese (77.8% vs 33.3%; p=0.022) and had a higher mean fasting glucose level (5.62 [5.27; 5.69] mmol/l vs 5.03 [4.82; 5.33] mmol/l; p=0.037). In addition, patients with hypogonadism were more often positive for anti-Scl70 (100.0% vs 40.7%; p=0.003) and had a trend towards higher titers of antinuclear factor (p=0.063). Significant inverse correlations were found between total testosterone levels and BMI, as well as antinuclear factor titer. Patients with IIМ and hypogonadism were characterized by a higher frequency of interstitial lung disease (66.7% vs 15.0%; p=0.012). Significant negative correlations were found between total testosterone levels and age, BMI and erythrocyte sedimentation rate. Conclusion. A high frequency of hypogonadism was shown in men with SSc and IIМ. Reduced testosterone levels were accompanied by some metabolic disorders, as well as a high frequency of antibodies and clinical features characteristic of a more unfavorable course of the disease.

Oftentimes, women with RA experience remission during pregnancy. The beneficial effect of pregnancy on the RA course is associated with a specific hormonal status, including high levels of estriol and progesterone that have known anti-inflammatory effects. After childbirth, decreased endogenous production of steroids can trigger the onset or exacerbation of RA.Objective. Studying of the characteristics of the gynecological status and concomitant extragenital diseases in postmenopausal women with rheumatoid arthritis (RA) depending on the presence of obesity.Materials and methods. 394 postmenopausal women with RA (diagnosed according to ACR/EULAR 2010 criteria) were included. By decision of the medical commission, all patients were approved for therapy with genetically engineered biological drugs and/or JAK kinase inhibitors. Before inclusion in the study, all patients had a detailed medical history, an allergic history, registered comorbidities, and a physical and laboratory-instrumental examination. Depending on the BMI values, the study participants were divided into groups. Group A included 103 obese patients of any severity (BMI ≥ 30 kg/m2). Group B included 291 women with BMI <30 kg/m2. Patients with an inflammatory process were found to have groups of inflammation by age and duration of RA (p > 0.05).Results. In patients of group A, more often than in patients of group B, comorbidities were detected: hypertension (p < 0.0001), coronary heart disease (p = 0.03), history of “vascular accidents” (p = 0.0009), especially acute cerebrovascular accident (p = 0.004), type 2 diabetes mellitus (p = 0.0005), which manifest themselves over the age of 45, that is, during the perimenopause. When correcting the gynecological history data, he draws attention to the fact that group A patients are more likely to operate surgically and on the pelvic organs: more had the uterus removed (p = 0.002) or ovarian resection was performed (p < 0.0001), and the frequency of surgical menopause in group A was higher than in group B (p = 0.0009). The debut of RA on average chronologically coincided with the onset of menopause (p = 0.01). At the same time, in the average age of the onset of menopause, it is rare (p > 0.05). The number of women who had a history of pregnancy, childbirth, miscarriages and abortions in the groups were repeated (p > 0.05). But in group A, the average number of pregnancies (p = 0.003) and abortions (p = 0.004) per woman was higher than in group B.Conclusion. The results of the study revealed the identification of clinical manifestations of inflammation and the severity of rheumatoid arthritis, depending on the presence of concomitant obesity in postmenopausal women, as well as a rarer occurrence of osteoporosis in women with RA and concomitant obesity.

Gout is the most common inflammatory joint disease, and its incidence increases with age and the presence of certain diseases, primarily obesity and chronic kidney disease, as well as while taking certain medications. Treatment of a patient with gout requires the interaction of a rheumatologist, cardiologist and endocrinologist, and even better, a well-trained therapist who is able to independently supervise gout-related diseases without the involvement of specialized specialists. This review was written to highlight current data on the most common endocrinopathies in gout for practitioners. The data presented indicate the existence of a relationship between gout and various endocrine diseases. The most important aspect is the presence of metabolic syndrome in most patients with gout, the treatment of which also requires taking into account the effect of prescribed drugs on purine metabolism. On the other hand, effects on certain endocrinological diseases can lead to improved purine metabolism. It has been shown that weight loss, including through bariatric means, is accompanied by a decrease in uric acid levels and may be accompanied by a decrease in the need for urate-lowering therapy. Most glucose-lowering drugs affect purine metabolism, and the presence of concomitant gout may determine the specific choice of antidiabetic therapy. Menopause is characterized by an increase in uric acid levels and the incidence of gout. At the same time, the use of menopausal hormone therapy may be accompanied by both a decrease in uric acid levels and the risk of developing gout. Despite the fact that an increase in testosterone levels in men is positively correlated with uric acid levels, its deficiency is accompanied not by a decrease, but by an increase in uric acid levels.

Aim. To study the frequency of hypogonadism (HG) in men with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and to evaluate the impact of HG on the course of RA and and concomitant diseases. Materials and methods. A single-stage continuous study included 170 men with RA, 57 men with AS and 85 men with PsA, who were hospitalized at the Nasonova Research Institute of Rheumatology. Patients were assessed for total testosterone (ТS) levels and subsequently divided into subgroups with normal (12 nmol/l) and reduced levels. An intergroup comparison was carried out on the main indicators used in clinical rheumatological practice to assess the stage, activity and other medical and demographic characteristics of rheumatic disease, as well as on concomitant conditions. The second stage of the study involved a pairwise intergroup comparison among patients with HG with RA, AS and PsA. Results. The incidence of ТS deficiency among patients with RA was 24.1%, among patients with AS – 17.5%, and with PsA – 31.8%. In patients with RA, HG was associated with a significantly higher mean body mass index, higher fasting blood glucose and uric acid, higher erythrocyte sedimentation rate and anemia. Patients with AS with HG had significantly lower hemoglobin levels and more frequent anemia, as well as higher levels of C-reactive protein and erythrocyte sedimentation rate. In PsA, older age was observed in the androgen deficiency group, as well as higher body mass index and fasting glucose levels; obesity was more common. An intergroup comparison of quantitative and qualitative indicators between patients with androgen deficiency in all three rheumatic diseases (RDs) did not reveal significant differences in the average concentrations of ТS, luteinizing hormone, sex hormone binding globulin, experience of RD, laboratory markers of inflammatory activity, as well as glucose and uric acid. A similar incidence of diabetes mellitus, obesity and anemia was noted for all three nosologies. Conclusion. ТS levels and the presence of HG were not associated with the stage and activity of RD, but ТS deficiency was accompanied by higher laboratory indicators of inflammatory activity, lower hemoglobin values, and metabolic disorders. Patients with HG, regardless of nosology, had similar levels of sex hormones and indicators reflecting RD and concomitant conditions.

Acromegaly is a chronic endocrine disease characterized by excessive secretion of growth hormone, which, in turn, leads to an increase in the secretion of insulin-like growth factor 1 in the liver. The targets for these hormones are most of the cells in our body. Excess growth hormone (in the vast majority of cases caused by hormone-producing pituitary adenoma – somatotropinoma), insulin-like growth factor leads to cellular, and tissue growth of almost all organs and systems, including the osteoarticular apparatus. Diagnosis of the disease in the early stages is often difficult and is established 5–10 years after the onset of symptoms, that leads to various complications and disability of patients. Often joint pain is the first manifestation of acromegaly. Damage to the musculoskeletal system causes a significant deterioration in the quality of life even when long-term stable remission of the underlying disease is achieved. In the article a clinical case with the peculiarities of diagnosing rheumatic disease in acromegaly is presented. A patient aged 56 years was diagnosed with acromegaly based on clinical and laboratory data, and a month later she underwent transnasal adenomectomy. However, Endocrinology Research Centre drew attention to the patient's complaints of pain in large joints, and therefore she was referred for a consultation to a rheumatologist at the Nasonova Research Institute of Rheumatology. As part of the examination, an increase in the titer of the antinuclear factor (1/2560) and the level of antibodies to ribonucleoprotein was revealed, which is most typical for mixed connective tissue disease. Treatment was prescribed and dynamic monitoring is being carried out.

Период пери- и постменопаузы характеризуется развитием множества социально значимых экстрагенитальных заболеваний, в том числе ревматических. Отмечена взаимосвязь между уровнем женских половых гормонов и активностью ревматических заболеваний. В настоящей публикации представлен клинический случай успешного применения менопаузальной гормонотерапии (МГТ) у пациентки с системной склеродермией (ССД). Показан рациональный подход к назначению МГТ с учетом оценки риска и выявления наличия возможных противопоказаний, а также возможного позитивного влияния МГТ и на течение ССД. Авторы не призывают назначать МГТ всем пациенткам с иммуновоспалительными ревматическими заболеваниями, однако ее применение при наличии реальных показаний может быть эффективно и безопасно. The period of peri- and postmenopause is characterized by the development of many socially significant extragenital diseases, including rheumatic ones. A relationship has been noted between the level of female sex hormones and the activity of rheumatic diseases. This publication presents a clinical case of the successful use of menopausal hormone therapy (MHT) in a patient with systemic scleroderma (SSc). A rational approach to prescribing MHT is shown, taking into account risk assessment and identifying the presence of possible contraindications, as well as the possible positive effect of MHT on the course of SSc. The authors do not call for prescribing MHT to all patients with immune-inflammatory rheumatic diseases, but its use in the presence of real indications can be effective and safe.

The aim – to study the incidence of hypogonadism in men with psoriatic arthritis (PsA) and to assess its impact on PsA and comorbidities.Materials and methods. A cross-sectional continuous study included 128 men with PsA who were hospitalized at the V.A. Nasonova Research Institute of Rheumatology. The patients underwent determination of their total testosterone levels and subsequent division into subgroups with normal (≥12.0 nmol/l) and reduced levels. An intergroup comparison was conducted for the main indicators used in clinical rheumatology practice to assess the stage, activity, and other medical and demographic characteristics of PsA, as well as for comorbidities. A correlation analysis was performed between the level of total testosterone and some clinical and laboratory parameters.Results. The incidence of reduced total testosterone levels was 36.7%. Patients with testosterone deficiency were older (47.9±10.3 vs 40.1±12.1 years; p<0.001), had a higher body mass index (31.2±5.2 vs 27.2±6.1 kg/m2; p<0.001) and were more often obese (48.9% vs 23.4%; p=0.001). They had higher mean glucose levels (5.9±1.39 vs 5.34±0.57 mmol/l; p=0.001) and frequency of impaired fasting glycemia with similar frequency of type 2 diabetes mellitus. Patients with hypogonadism were characterized by higher uric acid levels (402.9±99.3 vs 354.0±81.5 μmol/L; p=0.003) and the frequency of hyperuricemia. A lower proportion of HLA-B27 positive patients was noted in the hypogonadism group, as well as a more frequent occurrence of stage III sacroiliitis (p=0.004) and a smaller amplitude of lateral flexion in the spine (10.3±3.3 vs 12.4±4.3 cm; p=0.014). Significant negative relationships were found between total testosterone levels and age, body mass index, glucose and uric acid levels, as well as a positive relationship with the amplitude of lateral flexion and chest excursion.Conclusion. Hypogonadism was detected in one third of patients with PsA. Decreased testosterone levels were observed in older individuals and were associated with metabolic disorders, as well as with decreased spinal mobility and the presence of stage III of sacroiliitis.

Rituximab (RTM) is a chimeric (murine and human) monoclonal antibody against B-lymphocytes (CD20). RTM is widely used in hematology for lymphoproliferative diseases and in rheumatology for rheumatoid arthritis, Sjögren's disease, some types of vasculitis and systemic connective tissue diseases. The administration of RTM is associated with a depletion of B-cells mediated by the regulation of apoptosis and cytotoxic effects via complement-dependent and antibody-dependent mechanisms. Considering the pathogenesis of autoimmune damage in Graves' disease (GD), an autoimmune thyroid disease associated with thyrotoxicosis, the use of RTM could be effective in this pathology. We present three patients with a combination of diffuse toxic goiter and rheumatic pathology treated with RTM; different outcomes of GD were observed.

Glucagon-like peptide-1 receptor agonists (ArGLP-1) are effective drugs for the treatment of type 2 diabetes mellitus and obesity. Recent studies in patients with a wide range of immunoinflammatory diseases suggest important pleiotropic mechanisms of action of these drugs, primarily related to the suppression of inflammation. The article presents new data indicating the prospects for the use of ArGLP-1 in immunoinflammatory rheumatic diseases, which dictates the need for clinical studies. GLP-1 receptor agonists are effective drugs for the treatment of type 2 diabetes mellitus and obesity. Recent studies in patients with a wide range of immune-mediated diseases suggest important pleiotropic mechanisms of action of these drugs, primarily related to the suppression of inflammation. The article presents new data indicating the prospects for the use of ArGLP-1 in immune-mediated rheumatic diseases, which dictates the need for clinical studies.

Contraception is an important aspect of reproductive health in patients with rheumatic diseases. This is primarily due to the fact that in most immuneinflammatory rheumatic diseases (IRD) pregnancy must be planned. On one hand, the presence and activity of IRD can influence the course of the pregnancy, but on the other hand, pregnancy, which is accompanied by changes in general hormonal levels, is often a factor that alters the activity of IRD. Some patients take medication with potentially teratogenic effects. Planning a pregnancy during IRD can contribute to its optimal progression and minimize the risks of exacerbation of IRD. Given the wide range of barrier and hormonal contraceptives currently in use and the introduction of new drugs into clinical practice, data on the possibility of their use are of particular importance to rheumatologists in practical healthcare.

Diabetes mellitus type 2 (DM2) and gout develop as a result of metabolic disorders ; an obligatory component of both diseases is an increase in the level of a certain biochemical indicator – glucose in DM2 and uric acid in gout . Both nosologies are characterized by a chronic progressive course in the absence of treatment , and the goal of therapy is to achieve certain targets that depend in both cases on the " neglect " of the disease , as well as other factors . The relationship of disorders of purine metabolism and DM2 is shown by the results of large number of clinical studies . Taking into account the increasing incidence of both gout and DM2, paying attention to the fact that most of these patients are comorbid , the question of personification of therapy for these diseases is relevant . This review presents up-to-date data on the mechanisms of action and the effect on purine metabolism of the main groups of hypoglycemic drugs . Most drugs generally have a positive effect on urate metabolism , which is due to a direct or indirect effect on insulin resistance , and in some cases a specific mechanism of action of the drug .

The prevalence of obesity in the modern world is increasing. Obesity is an independent risk factor for some rheumatic diseases and also worsens their course. The presence of chronic joint disease can make it difficult for obesity to reduce activity, creating a vicious circle where joint pain makes exercise difficult and being overweight exacerbates joint pain. At the same time, there is a conditionally radical method of treating obesity - bariatric surgery (BS), which is currently used when conservative methods are ineffective. The purpose of this review is to analyze the data presented in the world literature on the impact of BS on the course of the most common rheumatic diseases. The available data show the possibility of a positive effect of BS not only on weight loss, but also on the course of a number of rheumatic diseases.

Premature ovarian insufficiency (POI) is a clinical syndrome defined as loss of ovarian function before the age of 40 years. Among the causes of POI are genetic, metabolic disorders, as well as infectious or iatrogenic factors, but in some cases the exact cause cannot be established. Given the possible association of ovarian failure with autoimmune disorders, as well as the detection of antibodies to normal ovarian tissue in the serum of patients with POI, it is assumed that an autoimmune mechanism is a significant cause of the syndrome. Taking into account the relationship between POI and autoimmune diseases, it seems relevant to address the issues of mutual influence of the ovarian function of women with POI and rheumatic diseases (in particular, systemic lupus erythematosus, rheumatoid arthritis and systemic scleroderma), which is presented in this review. Hormone replacement therapy may be recommended for women with POI to improve their quality of life. Keywords: premature ovarian insufficiency, menopause, anti-ovarian antibodies, systemic lupus erythematosus, rheumatoid arthritis, systemic scleroderma, rheumatic diseases, hormone replacement therapy.

The development of the modern world is manifested, inter alia, by an increase in the prevalence of obesity and cardiovascular diseases. Treatment of these conditions is associated with the need to prescribe multicomponent therapy, which complicates the control of drug interactions, leads to a decrease in compliance and polypharmacy. A large number of drugs taken in a particular patient dictates the need to search for drugs, the appointment of which contributes to the control of several diseases at once, can be successfully used in patients with reduced renal function, in the presence of cardiovascular diseases. The presented description of a clinical case demonstrates an example of the use of a type 2 sodium glucose cotransporter inhibitor – dapagliflozin in a patient with type 2 diabetes mellitus, chronic kidney disease, chronic heart failure and gout.

The emergence of modern methods of treatment of systemic lupus erythematosus (SLE) has led to an increase in the duration and quality of life of patients with this disease. However, the majority of patients with SLE are women, and it is well known that the female sex hormone estrogen can influence the activity of systemic autoimmune diseases, including SLE. An increase in life expectancy means an increase in the length of a postmenopausal woman’s stay, with the possibility of the appearance of classic menopausal disorders, and the development or aggravation of comorbid pathologies, primarily osteoporosis and cardiovascular diseases, as well as the need to improve the quality of life for women with these diseases. This review collects and analyzes data on the risks and benefits of using menopausal hormone therapy for SLE.

BACKGROUND:It has been suggested that the presence of chronic immunoinflammatory rheumatic disease (CIRD) may be a factor that increases the likelihood of developing hypogonadism syndrome, and conversely, the presence of uncompensated testosterone deficiency may predispose to a greater risk of developing or more severe course of ICRD. AIM:To study the incidence of hypogonadism in men with rheumatoid arthritis (RA) and evaluate its impact on the course of RA and concomitant diseases. MATERIALS AND METHODS:A one-time continuous study included 170 men with RA who were undergoing inpatient treatment at the Federal State Budgetary Institution NIIR named after. V.A. Nasonova. Patients were assessed for total testosterone levels and subsequently divided into subgroups with normal (&gt;12 nmol/l) and reduced levels. An intergroup comparison was carried out on the main indicators used in clinical rheumatological practice to assess the stage, activity and other medical and demographic characteristics of RA, as well as the state of purine and carbohydrate metabolism. A correlation analysis was performed between the level of total testosterone and some clinical and laboratory parameters. RESULTS:The frequency of detected testosterone deficiency in the study group was 24.1%. Significant correlations were noted between the level of total testosterone and body mass index (r=-0.29), the level of blood uric acid (r=-0.19) and C-reactive protein (r=-0.18). Patients with hypogonadism compared to the group with normal testosterone levels were characterized by higher body mass index (29.3±5.6 vs 26.3±4.0 kg/m2; p&lt;0.001), glucose levels (6.95±7 .85 mmol/l vs 5.42±1.13 mmol/l; p=0.034) and uric acid (354.6±110.7 vs 317.5±84.8 µmol/l; p=0.03) blood. In addition, patients with hypogonadism were more likely to suffer from obesity (41.6% vs 15.7%; p=0.001) and diabetes mellitus (21.6% vs 10.2%; p=0.075) without a statistically significant difference, and also had higher ESR (46.5±42.2 vs 31.0±30.9 mm/h; p=0.012). A more frequent occurrence of anemia was noted in hypogonadism (32.4% vs 16.7%; p=0.041). CONCLUSION:Testosterone levels and the presence of hypogonadism were not associated with the stage and activity of RA, however, testosterone deficiency was accompanied by a more frequent development of overweight and obesity, and a deterioration in purine and carbohydrate metabolism.

Rituximab is a chimeric (mouse and human) monoclonal antibody against B-lymphocytes (CD20). This drug is widely used in rheumatology in the treatment of rheumatoid arthritis, Sjogren’s syndrome, some systemic connective tissue diseases and vasculitis, as well as in hematology in lymphoproliferative diseases. Administration of rituximab leads to depletion of B-lymphocytes through various mechanisms, including antibody-dependent and complementdependent cytotoxic effects, as well as the regulation of apoptosis. Considering the mechanism of autoimmune damage in Graves’ disease, an autoimmune thyroid disease accompanied by thyrotoxicosis and endocrine ophthalmopathy (an autoimmune lesion of the accessory apparatus of the eye), the use of rituximab may be effective in these diseases. The review considers the currently available results of studies on the use of various doses of rituximab in these diseases.