BACKGROUND: One of the complications in patients with systemic sclerosis (SSc) that carries an unfavorable prognosis is pulmonary hypertension (PH). Currently existing algorithms for detecting PH in patients with SSc require a large number of expensive tests, which complicates the possibility of their use in routine practice. The introduction of parameters assessed during nailfold capillaroscopy into the diagnostic algorithm may be promising for detecting PH in patients with SSc. AIM: To develop a new algorithm for detecting PH in patients with SSc, incorporating assessment of nailfold capillaroscopy parameters. METHODS: The study included patients with a diagnosis of SSc verified in accordance with the 2013 ACR/EULAR criteria. Patients underwent echocardiographic examination. When indirect signs of PH were detected, right heart catheterization was performed to verify the diagnosis. Patients underwent nailfold capillaroscopy with assessment of capillary density, pattern, distance between capillary loops, width of the capillary loop apex, width of the capillary loop at its widest point, with semiquantitative assessment of capillary density and alterations. To obtain a model and nomogram for predicting the probability of PH in patients with SSc, predictive modeling was performed using the R 4.3.2 environment. RESULTS: Of the 101 patients included in the study, 27 were diagnosed with PH. In patients with PH, greater capillary loop width at the widest point (p = 0.012) and at the apex (p = 0.009), greater distance between capillary loops (p = 0.027), lower capillary density (p 0.001), late scleroderma pattern (p = 0.005), and higher scores for capillary density (p = 0.016) and alterations (p 0.001) were identified. Based on the obtained data and echocardiography data, an algorithm for detecting PH in patients with SSc was developed, with 100% sensitivity [95% CI 87.2–100.0] and 98.6% specificity [95% CI 92.7–100.0]. CONCLUSION: The developed algorithm for detecting PH in patients with SSc has high sensitivity and specificity and requires performing simple non-invasive studies: echocardiography (with measurement of the tricuspid regurgitation gradient and the ratio of the right ventricular diameter to the left ventricular diameter) and nailfold capillaroscopy (with assessment of capillary density and measurement of the capillary loop width at its apex). However, this algorithm requires further external validation to adjust the sensitivity and specificity data of the method.

BACKGROUND: Osteoporosis is a systemic metabolic skeletal disease characterized by decreased bone mass and impaired bone microarchitecture, leading to bone fragility and low-trauma fractures. Osteoporotic fractures represent a significant public health concern in the Russian Federation, reducing patients' quality of life and being associated with disability and high mortality. Timely diagnosis of a high fracture risk is crucial in the management of osteoporosis. AIM: To investigate the comparability of the results from dual-energy X-ray absorptiometry (DXA) and radiofrequency echographic multi-spectrometry (REMS) in assessing bone status in postmenopausal women. METHODS: A cross-sectional study was conducted on the basis of the Clinical Rheumatology Hospital No. 25 named after V.A. Nasonova and the North-Western State Medical University named after I.I. Mechnikov. DXA of the lumbar spine (L1–L4) and proximal femur (femoral neck and total hip) was performed using a Lunar Prodigy Advance machine (USA). REMS was carried out using a specialized echographic device EchoStation (Echolight Spa, Italy). RESULTS: The study included 50 women with postmenopausal osteoporosis, the median age was 73.0 [48.0; 77.0] years. The mean T-score values for the spine and femoral neck assessed by DXA and REMS were comparable and amounted to: –2.4 standard deviations (95% confidence interval from –2.7 to –1.8) versus –2.2 standard deviations (95% confidence interval from –2.7 to –2.0) and –0.045 ± 0.084 g/cm2 (95% CI from –0.069 to –0.021) versus –0.210 ± 0.084 g/cm2 (95% CI from –0.233 to –0.186), respectively. When assessing the correlation between REMS and DXA in the spine, a high positive correlation was found between the T-scores of REMS and DXA (r = 0.769; high strength of association according to the Chaddock scale; p 0.001). A high positive correlation was also found between the T-scores of REMS and DXA for the femoral neck (r = 0.873; high strength of association according to the Chaddock scale; p 0.001). When evaluating the DXA and REMS results using the Bland-Altman method, a sufficiently high degree of comparability of the two methods was found, although a small proportional bias was observed in both areas. REMS on average showed higher bone mineral density values than those with DXA. CONCLUSION: The results of REMS and DXA are comparable, which allows their use for the diagnosis of osteoporosis.

Patients with rheumatic diseases exhibit a markedly increased risk of developing and accelerating cardiovascular pathology, which is largely attributed to the significant role of chronic inflammation as one of the etiological factors in both atherogenesis and heart failure. Achieving sustained clinical and laboratory remission of the Immune-mediated inflammatory disease has been shown to reduce the risk of cardiovascular complications. Given the direct association between persistent inflammation and a wide range of comorbid conditions, this factor must be carefully considered when planning and implementing rational pharmacotherapy in multimorbid patients. It is well established that pharmacological agents used in rheumatology exert diverse effects on the cardiovascular system. Over the past decade, growing research interest has been directed toward the potential application of anti-inflammatory agents with different mechanisms of action for both the prevention and treatment of atherosclerosis and ischemic heart disease. Particular attention has been paid to the modulation of the “NLRP3 inflammasome – interleukin-1 – interleukin-6 – C-reactive protein” signaling pathway. According to several studies, inhibition of this cascade may contribute to reduced likelihood of cardiovascular events. This review summarizes current data on the effects of various classes of antirheumatic drugs on the cardiovascular system, including both their beneficial and adverse effects.

BACKGROUND: The selection of surgical strategies for large adrenal tumors remains clinically critical. For determining eligibility for endoscopic video-assisted surgery, the absence of malignancy features is essential. Steroid metabolome analysis by gas chromatography-mass spectrometry (GC-MS) provides the highest diagnostic yield for detecting early signs of malignancy during preoperative evaluation and, according to multiple studies, exceeds the accuracy of radiologic imaging techniques. AIM: To evaluate the clinical utility of urine steroid profiling by GC-MS for preoperative diagnosis and surgical decision-making in large malignant adrenocortical neoplasms. METHODS: Patients with adrenal tumors larger than 50 mm and without clinical or laboratory signs of hypercortisolism were examined. Based on histological analysis, the following diagnoses were established: adrenocortical carcinoma, adrenocortical adenoma (with malignancy grade assessed using the Weiss scoring system), and rare adrenal diseases (schwannoma, ganglioneuroma, myelolipoma, etc.). Patients with adrenocortical adenomas smaller than 50 mm served as the control group. Urinary steroid profiles were analyzed by gas chromatography-mass spectrometry in all patients before surgical treatment. The Mann-Whitney U test was used for comparison of urinary steroid excretion. RESULTS: According to gas chromatography-mass spectrometry (GC-MS), 23 patients (33.8%) with adrenal tumors 50 mm exhibited biochemical features of adrenocortical carcinoma (ACC) prior to surgery, which was later confirmed histologically. In patients with adrenocortical adenoma and a malignancy score of 2 on the Weiss scale (n = 16, 23.5%), urinary excretion of tetrahydro-11-deoxycortisol, androgens, progestogens, and mineralocorticoids was significantly higher than in patients with adrenocortical adenoma lacking malignant features (n = 14) and the control group (n = 30). No statistically significant differences were observed in the urinary excretion of 9 ACC biomarkers compared to patients with confirmed ACC. Open adrenalectomy was recommended for patients with large adrenal tumors and GC-MS evidence of malignancy. CONCLUSION: Preoperative GC-MS detection of early malignant features in large adrenal tumors is critical for determining the optimal surgical approach. Minimally invasive adrenalectomy is not recommended for large adrenal lesions with GC-MS signs of malignancy.

Background. Non-pharmacological treatments based on collagen as a dietary supplement are emerging as a new area of interest to support preventive or therapeutic effects in patients with osteoarthritis (OA). Aim. In a multicenter, prospective, double-blind, placebo-controlled, randomized study, to evaluate the effectiveness and safety of the use of the Artneo complex containing undenatured chicken collagen type II in patients with OA of the knee joints. Materials and methods. The study enrolled 212 outpatients from 12 centers in the Russian Federation with knee OA, stages II and III according to the Kellgren–Lawrence classification. The participants included 171 women (80.7%) and 41 men (19.3%), with an average age of 60.2±9.0 years (range: 40 to 75 years). The study population was randomly allocated in equal proportions into two groups using an interactive web response system (IWRS). Group 1 (Artneo) consisted of 106 patients who took one capsule of the drug once daily for 180 days. Group 2 (Placebo) also had 106 patients, with the dosage form and regimen identical to Group 1. During the treatment period, the following outcomes were assessed: WOMAC index, KOOS, pain according to VAS, quality of life using the EQ-5D questionnaire, and the need for NSAIDs. All patients underwent a clinical blood test, general urine analysis, biochemical blood test, and ultrasound examination of the affected knee joint. Results. In a prospective, double-blind, placebo-controlled, randomized study, it was demonstrated that the Artneo combination, containing undenatured chicken collagen type II, has a positive effect on all clinical manifestations of OA: it effectively reduces pain, stiffness, and improves the functional state of joints and quality of life. It has a good safety profile and is superior to placebo in all parameters studied. Conclusion. The results of the study confirm the good effectiveness and safety of the Artneo combination in patients with OA of the knee joints.

COVID-19 is similar to immunoinflammatory rheumatic diseases in clinical manifestations, immune responses and pathogenetic mechanisms. Specific autoantibodies as markers of autoimmune diseases can be detected in patients with coronavirus infection. Most often, after COVID-19, antinuclear antibodies, antibodies to phospholipids, to cardiolipin, to β2-glycoprotein, to cytoplasmic antigens SS-A and SS/B, and cyclic citrulline-containing peptide are detected. In moderate and severe cases of COVID-19 infection with pulmonary-renal syndrome, cytokine storm, antineutrophil cytoplasmic antibodies, antibodies to myeloperoxidase and to proteinase 3 have become more frequent, which can trigger neutrophil NETosis with the formation of extracellular neutrophil traps — networks and induce the development of autoimmune processes and the appearance of de novo immunoinflammatory rheumatic diseases: arthritis , systemic lupus erythematosus, vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA vasculitis). Our study presents 4 clinical cases of patients with ANCA vasculitis with a history of recent coronavirus infection, chronologically verified. The average time after COVID-19 and the onset of ANCA vasculitis was about 3 months; damage to the upper respiratory tract, lower respiratory tract, skin and renal syndromes were observed. The severity of ANCA vasculitis did not depend on the severity of coronavirus infection: a mild course of COVID-19 infection did not exclude a severe course of ANCA vasculitis. It is recommended that all patients during and after coronavirus infection with post-COVID syndrome in the presence of damage to the ENT organs, kidneys, and skin are screened the presence of antineutrophil cytoplasmic antibodies to exclude the onset of ANCA vasculitis.

A meeting of the Expert Council on September 9, 2023 considered the last challenges in the treatment of osteoarthritis (OA) including OA in comorbid patients. Leading experts in rheumatology, traumatology and other relevant disciplines participated in the meeting. The key goal of Expert Council was the discussion of potential application of a combination of undenatured (native) type II collagen, methylsulfonylmethane, boswellic acids, vitamins C and D (Artneo complex) as a part of complex OA therapy. The experts concluded that Artneo for stage I–III knee OA patients is not just non-inferior in comparison with a combination of chondroitin sulfate and glucosamine hydrochloride but excels it in the decrease of magnetic resonance imaging synovitis markers and dynamics of Lequesne index for knee osteoarthritis severity. The proven efficacy and the favorable safety profile of 6-months Artneo course deserve the attention of medical community and the active implementation of Artneo complex into ambulatory practice, first of all, for the treatment of patients with mild or moderate synovitis and/or burdened with comorbidities.

BACKGROUND: Osteoporosis is a metabolic skeletal disease characterized by decreased bone mass, impaired microarchitecture of bone tissue and, as a consequence, fractures with minimal trauma. The social significance of osteoporosis is determined by its consequences — fractures of the vertebral bodies and bones of the peripheral skeleton, leading to high medical costs and causing a high level of disability, including disability and mortality. Osteoporosis is most often combined with cardiovascular diseases caused by atherosclerosis, which are widespread and are the leading cause of disability and mortality. A small number of studies have been devoted to the study of the features of clinical manifestations of cardiovascular diseases in the combination of coronary heart disease and osteoporosis. AIM: To identify the frequency and severity of comorbid diseases and their risk factors in postmenopausal osteoporosis. MATERIALS AND METHODS: A retrospective and prospective cohort study was conducted from 2013 to 2023. 8250 women with postmenopausal osteoporosis were examined and the data from the medical records of these patients who applied to the Osteoporosis Center of the North-Western State Medical University named after I.I. Mechnikov of the Ministry of Health of the Russian Federation from 2013 to 2020 were analyzed. At the prospective stage, two comparison groups of 100 patients with and without postmenopausal osteoporosis were formed from 500 patients with comorbid diseases (coronary heart disease, hypertension, type 2 diabetes, stroke, transient ischemic attack). Bone mineral density was assessed based on the Hologic Discoveri Wi dual-energy X-ray absorptiometry at 2 points in the lumbar spine (L1–L4) and the femoral neck. Along with traditional laboratory examination methods, bone metabolism markers (total calcium, phosphorus, vitamin D, urine analysis for deoxypyridinoline, C-terminal telopeptide of type 1 collagen, osteocalcin, alkaline phosphatase, parathyroid hormone) were assessed dynamically. In all the patients, along with a general clinical examination, an assessment of risk factors for cardiovascular disease and osteoporosis was performed. RESULTS: Body mass index was higher in the group of patients with osteoporosis — 28.4 (26.9–32.4) kg/m2 (p 0.001), versus 27.64 (25.8–30.0) kg/m2 (p 0.05). Bone mineral density in the group of patients with osteoporosis was statistically lower than in the group without osteoporosis. In the group of patients with osteoporosis, the risk of fractures was high and amounted to 37 (95% confidence interval 15.0–38.50) %, p 0.001), versus in the control group 9.55 (95% confidence interval 7.67–15.0) % (p 0.001) according to the FRAX questionnaire for the Russian Federation. In the group of patients with osteoporosis, the Charlson index values were 5.1 (95% confidence interval 4.7–5.6) points. As a result of the correlation analysis, a reliable positive relationship was revealed between low bone mineral density L1–L4 and hip with bone metabolism: alkaline phosphatase, C-terminal telopeptide of type 1 collagen, vitamin D, osteocalcin, urinary deoxypyridinoline. We found a negative relationship between bone mineral density and the Charlson index, absolute ten-year risk of hip fracture and the duration of early menopause, and the level of hypertension. To assess the dependence of QRISK3-2018 on osteoporosis risk factors in the group of patients with osteoporosis, multiple linear regression was performed. This model was characterized by a statistically significant correlation between the factors and the dependent variable of high tightness. The coefficient of determination was 0.608, indicating a 60.8% contribution of the factors taken into account in the model to the variance of QRISK3-2018. CONCLUSIONS: In women with postmenopausal osteoporosis, comorbid pathology is more common, aggravating the course of the disease. Knowledge of the prevalence of concomitant pathology and joint risk factors will make it possible to simultaneously form groups at increased risk of development, which will ensure prevention of both diseases with the same non-medical means and drugs.

Patients suffering from rheumatic diseases are at high risk of the development and accelerated progression of cardiovascular due to inflammation as one of the etiological factors of atherogenesis and heart failure. To choose the rational and safe treatment, especially in comorbid patients, it is necessary to have a comprehensive and complete understanding of the mechanisms of these relationships, as well as the most accurate determination of cardiovascular risk using modern validated scales. The first part of the review presents the results of current experimental and clinical studies on the effect of the chronic inflammatory and its biomarkers on the development, course and prognosis of cardiovascular diseases.

BACKGROUND: Analysis of the effect of comorbid diseases on the concentration of biomarkers will help to deepen the understanding of the pathogenetic mechanisms of the impact of comorbid diseases on the course of COVID-19 and adjust prognostic models for its therapy. AIM: To study the impact of comorbid diseases on the severity and outcomes of COVID-19. In addition, an analysis of the levels of macrophage-derived chemokine, interferon-γ-induced protein 10 kD, soluble CD40 ligand, vascular endothelial growth factor has been carried out in 472 patients with COVID-19, depending on the presence of various forms of comorbid pathology. MATERIALS AND METHODS: To study the concentration of biomarkers an analysis has been conducted in a group of 1648 patients with confirmed COVID-19. The study assessed intergroup differences (disease outcome/severity of disease) in the general group (1648 patients) and in the group of patients without comorbidity (343 patients) — Charlson index less than 2 points. 472 medical histories of patients with COVID-19 have been analyzed, including with certain concentrations of the studied biomarkers and comorbid pathology included in the Charlson Index. For comparison, two samples have been formed: an experimental group consisting of patients with COVID-19 and the presence of a certain comorbid disease and a control group consisting of patients suffering from COVID-19 without a specified comorbid disease. RESULTS: For the first time, data has been obtained indicating that patients with COVID-19 have comorbid conditions with the levels of the studied biomarkers differing significantly from the indicators of the control group. Thus, in patients with arterial hypertension (I10–I15 according to the International Classification of Diseases, 10th revision), chronic heart failure (I50.0), diseases of the vascular system (I70–I79), cerebrovascular diseases (I60–I69), chronic kidney disease (N17–N19), the level of the macrophage-derived chemokine biomarker was significantly lower than in the patients without these diseases. At the same time, in the COVID-19 patients with respiratory diseases (J40–J47), the levels of interferon-γ-induced protein 10 kD and vascular endothelial growth factor were significantly lower than in the patients who did not have lung diseases. CONCLUSIONS: The study findings obtained have confirmed the role of signaling biomarkers in the development of severe forms and death in patients with COVID-19. Significant influence of comorbid pathology on the course of the new coronavirus infection has been shown.

Aim. To evaluate the efficacy of Artneo (AN) in comparison with a combination of glucosamine hydrochloride and chondroitin sulfate (GC) in patients with osteoarthritis (OA) of the knee joint (KJ). Materials and methods. 70 patients with stages I–III of primary knee OA were randomized into 2 groups. Participants in the 1st (n=35) took AN 1 caps/day, in the 2nd (n=35) GC according to the standard regimen. After 7, 30, 90, 180 days, the Lequesne index (severity of OA), pain when moving according to VAS, WOMAC score were assessed, after 1, 3, 6 months – quality of life SF-36 and morning stiffness, after 6 months – MRI with T2 mapping, laboratory safety indicators. Results. Over the course of 6 months of use, an improvement in the WOMAC index and a decrease in pain were observed without intergroup differences, and a greater decrease in stiffness in the AN group. After 3 months, the severity of OA decreased from moderate to mild in the AN group and was significantly lower compared to the GC group; quality of life (physical component of SF-36) was higher in the AN group. After 6 months, there was an improvement in cartilage ultrastructure (T2 relaxation time) in both groups and a more pronounced reduction of the synovitis area (MRI) in the AN group (2.95 and 1.37 times in the AN and GC group, respectively). There were no clinically significant adverse reactions observed in both groups. Conclusion. The use of AN in patients with stage I–III primary knee OA was not inferior in efficacy to the combination of GC. Further studies with greater statistical power (sample size) and follow-up period are warranted including in real clinical practice.

The presented study has been carried out to identify the effect of urate-lowering therapy with xanthine oxidase inhibitors on glomerular filtration rate and serum uric acid in patients with asymptomatic hyperuricemia and chronic kidney disease. A systematic review of randomized controlled trials has been conducted; its results based on meta-analysis has been evaluated. A systematic search and selection of publications in Embase, PubMed, Cochrane Library, and eLibrary databases has been performed. The studied drugs were xanthine oxidase inhibitors: allopurinol and febuxostat. The study considered the following parameters such as efficacy endpoints, namely, glomerular filtration rate and serum uric acid after 3–15 months of follow-up. Clinical and methodological heterogeneity of the included randomized controlled trials has been assessed as well as publication bias and risk of systematic error. Synthesis has been performed using bivariate meta-analysis assessing residual statistical heterogeneity. 7 selected randomized controlled trials (1203 patients) have been included in the meta-analysis. This analysis revealed that medication urate-lowering therapy (allopurinol or febuxostat) was associated with higher glomerular filtration rate (+3.0 ml/min/1.73 m2; 95% confidence interval +0.4 to +5.6; p = 0.022) compared with the controls (placebo/no urate-lowering therapy) at 3–15 months of follow-up. Along with this, medication urate-lowering therapy (allopurinol or febuxostat) has been found to result in lower serum uric acid (−3.3 mg/dl; 95% confidence interval −3.8 to −2.8; р 0.001) compared to the controls (placebo / no urate-lowering therapy) at 3–15 months of follow-up. The results of the meta-analysis have demonstrated a positive role of allopurinol and febuxostat in increasing glomerular filtration rate and decreasing serum uric acid in patients with chronic kidney disease and asymptomatic hyperuricemia. The presented data suggest that therapeutic measures aimed at the elimination of asymptomatic hyperuricemia, including the use of xanthine oxidase inhibitors, may be important in slowing the progression of chronic kidney failure and may be additional factors of nephroprotection.

This clinical observation describes a case of a fulminant course of an atypical hemolytic-uremic syndrome. The initial stage of the course of the disease is of particular interest, which was not accompanied by typical manifestations of atypical hemolytic-uremic syndrome according to the type of acquired autoimmune hemolytic anemia. Thus, revealing this clinical observation may help in the diagnosis of atypical hemolytic-uremic syndrome with atypical initial manifestations and avoid errors, delays and adverse outcomes of this disease.

Disseminated seronegative echinococcosis, occurring with damage to soft tissues, bones and joints, is a rare variant of the course of helminthiasis, often associated with diagnostic difficulties, a high probability of complications and difficult treatment. This article presents a case of disseminated seronegative echinococcosis, clinically and laboratory simulating a severe form of WeberChristian panniculitis complicated by sepsis. The advantages and disadvantages of serological and morphological studies in the verification of disseminated echinococcosis are discussed, as well as the feasibility of using repeated histological studies in cases of echinococcosis under the masks of rheumatic diseases.

BACKGROUND: Patients with rheumatoid arthritis have a high level of comorbidity, and their most common and socially significant conditions are cardiovascular diseases, which represent a major cause of mortality. Currently, there are no data on the differences in cardiovascular risk scales in patients with rheumatoid arthritis depending on the presence or absence of thrombocytosis. AIM: To assess and compare cardiovascular risk according to conventional scales in patients with thrombocytosis and normal thrombocytes. MATERIALS AND METHODS: The study involved 85 patients diagnosed with rheumatoid arthritis: 40 with thrombocytosis [including 25 (62,5%) women] and 45 with normal thrombocytes [including 29 (64,4%) women]. The following scales were used to assess risk of cardiovascular complications: Systematic COronary Risk Evaluation with adjustment factor 1.5 (mSCORE), Reynolds Risk Score (RRS), QRESEARCH Cardiovascular Risk Algorithm (QRISK3), Assessing Cardiovascular Risk to Scottish Intercollegiate Guidelines Network / SIGN to Assign Preventative Treatment (ASSIGN). RESULTS: The obtained findings have demontrated that according to the mSCORE and RRS scales the patients of both groups had almost identical parameters; however, according to the ASSIGN and QRISK3 high risk of cardiovascular complications has been detected nearly twice as frequently in the patients with rheumatoid arthritis and thrombocytosis in comparison with those with normal level of thrombocytes. It is also worth noting that more frequent determination of high risk of cardiovascular complications by the QRISK3 was statistically significant. CONCLUSIONS: The QRISK3 calculation has shown significantly higher prevalence of high-risk cardiovascular complications among the patients with platelet counts 450 ∙ 109/l compared with those with platelet levels within the reference values. Thus, the QRISK3 scale can be considered as more informative for estimating risk of cardiovascular complications in rheumatoid arthritis.

In recent years, new data have been obtained confirming the role of inflammation as the leading pathogenetic mechanism for the development of atherosclerosis and its complications. In addition, atherosclerosis is considered in the spectrum of atypical autoinflammatory diseases. The aim of the paper is to highlight the role of inflammation in the development and progression of atherosclerosis and other cardiovascular diseases as well as to identify new therapeutic targets for the treatment of cardiovascular disease. The search has been performed in the PubMed, e-library, Embase, ClinicalTrials.gov databases, using the keywords: inflammation, NLRP3 inflammasome, TNF-, IL-1 blocker, atherosclerosis, cardiovascular disease. As a result, 210 references have obtained; the results of 15 clinical studies have been selected for the final analysis as well as 15 papers containing the results of original studies with access to the full text articles in Russian or English. The analysis of literature sources revealed that inflammation plays a crucial role in the development of cardiovascular diseases, and modern anti-inflammatory therapy is a promising, pathogenetically justified strategy for the prevention and treatment of cardiovascular diseases.

BACKGROUND: Group of spondyloarthritis include not only damage of musculoskeletal system, oftenly it’s combination with a variety of comorbid pathologies, primarily involving the cardiovascular system, is characteristic. Given the high importance of early detection, assessment and further prediction of the risks of cardiovascular diseases in this cohort of patients, a competent interpretation of the risks of aggravating cardiovascular diseases and their prevention is one of the priority tasks not only for rheumatologists, but also for specialists in related fields. AIM: To study the structure of comorbid pathology and assess the frequency of cardiovascular diseases in patients with ankylosing spondylitis, psoriatic arthritis and psoriatic spondyloarthritis, to conduct a comparative analysis of the incidence of cardiovascular comorbidities in different groups of spondyloarthritis. MATERIALS AND METHODS: The study included 153 patients with a verified diagnosis of spondyloarthritis. Patients were divided into 3 groups depending on the nature of the lesion of the musculoskeletal system: ankylosing spondylitis meeting the modified New York criteria for ankylosing spondylitis (1984) (n = 53), psoriatic arthritis meeting the CASPAR criteria (Classification criteria of Psoriatic Arthritis, 2006) (n = 40) and psoriatic spondylitis simultaneously meeting the modified New York criteria for ankylosing spondylitis and the CASPAR criteria for psoriatic arthritis (n = 60). All patients taken with monoclonal antibodies (inhibitors TNF-alpha). RESULTS: When studying cardiovascular comorbidity in patients with spondyloarthritis in three groups, arterial hypertension was most common in the ankylosing spondylitis group — 37.7%, in psoriatic arthritis — 62.5%, in the psoriatic spondyloarthritis group — 51.7%, conduction disturbance in ankylosing spondylitis — 28, 3%, in psoriatic arthritis — 17.5%, in the psoriatic spondyloarthritis group — 18.3%, dyslipidemia is significantly more common in the psoriatic arthritis and psoriatic spondyloarthritis groups — 47.5% and 51.7%, respectively, compared with the ankylosing spondylitis group — 18.9%. Along with cardiovascular diseases, endocrine disorders were detected with a high frequency of occurrence: overweight was more common in patients of the psoriatic arthritis and psoriatic spondyloarthritis groups — 35.0 and 38.3%, respectively, significant differences in the incidence of type 2 diabetes mellitus in the three groups has not been identified. CONCLUSIONS: It is necessary to carry out medical examination in order to identify comorbidities in patients with various forms of spondyloarthritis, in order to determine further tactics of management and correction, depending not only on the activity of the disease, but also taking into account comorbidities.

BACKGROUND: Osteoarthritis is a disease highly associated with a wide range of comorbidities, which leads to significant limitations of the therapeutic possibilities, in particular, the long-term use of non-steroidal anti-inflammatory drugs. Thus, develop algorithms for effective treatment of osteoarthritis aimed at reducing the need for anti-inflammatory therapy is of great importance. AIM: To evaluate the efficacy and safety of hyaluronic acid for the treatment of osteoarthritis in patients with comorbid pathology. MATERIALS AND METHODS: 30 patients aged 40 to 65 years with IIIII stages of knee osteoarthritis who received treatment with the hyaluronate sodium were examined according to the KellgrenLawrence scale. The course of treatment included standard intra-articular injections of Revisk (sterile sodium hyaluronate gel obtained by microbial fermentation) into the knee joints once a week, in a course of 3 injections. During the study non-steroidal anti-inflammatory drugs therapy was allowed at stable standard dosages. The effectiveness of treatment was assessed by changes in the WOMAC index, the Visual Analog scale pain scores for pain on movement, at rest, goniometry data, 30-meters walking test and stair climb test. RESULTS: A positive effect of treatment on all the parameters has been noted: significant improvement in clinical indicators of pain according to the visual analog scale, functional tests, and the WOMAC index scores. The positive dynamics of the estimated parameters during treatment started from the 7th day of therapy. CONCLUSIONS: The hyaluronate sodium (Revisk) can be used for treating patients with IIIII stages of knee osteoarthritis with moderate dysfunction of joints.