Currently, it is considered generally accepted to assess the activity of inflammation in rheumatoid arthritis (RA) according to the disease activity index (DAS28), which requires computer technology. However, there have been reports that inflammatory activity in autoimmune diseases can be diagnosed with peripheral blood counts.Aim. To clarify the possibility of using peripheral blood parameters for the diagnosis of inflammatory activity in rheumatoid arthritis.Material and methods. The study included 100 patients with RA who were consecutively hospitalized in the first quarter of 2021 due to an exacerbation. The control group consisted of 59 healthy donors. When patients were admitted to the clinic, along with standard clinical, laboratory and radiological parameters, the neutrophil-tolymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios were determined.Results. Correlation analysis of the studied clinical and laboratory parameters of the inflammatory activity of RA patients using the Pearson method showed that the NLR indicator, in contrast to the PLR, was statistically significant (p<0.05) correlated with the swollen joint count (r=0.236), the values of C-reactive protein (CRP) (r=0.448), erythrocyte sedimentation rate (ESR) (r=0.274) and DAS28-ESR (r=0.274). ROC-analysis of the sensitivity and specificity of the NLR value in relation to the CRP and ESR indicators confirmed an acceptable level of sensitivity and specificity in assessing the inflammatory activity of RA.Conclusions. The NLR index, calculated from the data of the analysis of peripheral blood, can be used in clinical practice as an objective and accessible marker of the inflammatory activity of RA.

Objective: to assess whether the modified combined glucocorticoid (GC) toxicity index (MCGTI) can be used to analyze adverse reactions (ARs) to GCs administered in the management of rheumatoid arthritis (RA).Subjects and methods. The investigation enrolled 71 RA patients (57 females, 14 males; mean age, 51.7+15.2 years). All the patients met the ACR/EULAR classification criteria and took GCs (the median duration of GC treatment duration was 7.1 [0.9; 12.0] years). In addition to the standard clinical, laboratory, and instrumental indicators, the daily and cumulative doses of GCs (in prednisolone equivalent) and MCGTI were analyzed.Results and discussion. The value of MCGTI statistically significantly correlated with treatment duration (r=0.411), age (r=0.384), and the cumulative dose of GCs (r=0.361), but did not correlate with their maximum dose (r=0.06). A ROC analysis showed that the critical level of the cumulative dose of GCs in relation to MCGTI was 17,337.5 mg.Conclusion. MCGTI correlates with cumulative dose (making it possible to establish its critical level), treatment duration, and age, which is the basis for further study of whether this can be applied in clinical practice to evaluate, predict, and prevent ARs.

In clinical practice, acute-phase protein measurements during inflammation are usually used to monitor the activity and severity of adult-onset Still's disease (AOSD).Objective: to study the possibility of using the neutrophil-to-lymphocyte ratio (NLR) in complete blood cell count as a marker for the activity and severity of AOSD in clinical practice.Patients and methods. The investigation enrolled 48 patients (29 females and 19 males; mean age, 32.8±12.5 years) with active AOSD, who met the criteria devised by M. Yamaguchi et al. Along with standard clinical and laboratory parameters and systemic scores, NLR was calculated in complete blood cell count.Results and discussion. There was a statistically significant correlation of NLR with the level of CRP (r=0.532), ferritin (r=0.43), ESR (r=0.40), and the systemic score reflecting the severity of the disease (r=0.449), which allows NLR to be regarded as a tool that is convenient to assess the activity and severity of AOSD in clinical practice.Conclusion. The findings have shown the good sensitivity and specificity of NLR, which indicates the possibility of using the latter as an available marker for assessing the activity and severity of AOSD in clinical practice.

The paper discusses prospects for prescribing tumor necrosis factor-α (TNF-α) inhibitor biosimilars, their interchangeability with original drugs for inflammatory joint diseases. It describes clinical cases when original infliximab is replaced with its biosimilar Flammagis for ankylosing spondylitis. The authors emphasize that it is difficult to predict the interchangeability of original TNF-α inhibitors and biosimilars in rheumatology, and this is confirmed by the above clinical cases. They also indicate that the optimal use of biosimilars requires a constant cooperation of rheumatologists, pharmacologists, and regulatory authorities, which is aimed at protecting the rights of a patient in order to ensure safe, effective and high-quality care. It is concluded that it is advisable to conduct further investigations to develop a special pharmacovigilance system in this area.

The paper describes the occurrence of polyarteritis nodosa in a patient with rheumatoid arthritis during treatment with tofacitinib. It considers the reasons why this condition should be regarded as an unforeseen borderline paradoxical adverse reaction.

Aim.To evaluate the diagnostic significance of serum calprotectin (SC) in patients with adult-onset Still's disease (AOSD).Material and methods.The level of SC was determined in 48 (29 women and 19 men, average age 32.8±12.5 years) patients with AOSD who meet the classification criteria of Yamaguchi and al.Results.The level of SC was increased in 87.5% of patients with AOSD and statistically significantly correlated with non-specific prameters, including serum ferritin, C-reactive protein, blood leukocytes count, ESR, and systemic count.However, the clinical classification criteria of AOSD, including rash, serositis, splenomegaly, hepatomegaly or hepatic impairment, sore throat, did not depend on the level of SC. Conclusion.The results of our study suggest that SC cannot be regarded as a specific serological marker of AOSD.

The review presents current data on still disease, which has developed in adults, concerning the causes of its occurrence, features of pathogenesis, diagnosis, clinical picture (with the release of subtypes), treatment, taking into account the nature of the course and life-threatening complications.

The review gives an update on adult-onset Still’s disease: on its causes, the specific features of its pathogenesis, diagnosis, clinical presentations (with identification of subtypes), and treatment with consideration for the nature of the course of the disease and life-threatening complications.

The paper describes a case of infliximab-induced lupus-like syndrome in a female patient with rheumatoid arthritis and discusses the possible causes of this pathology.

The lecture gives an update on adult-onset Still's disease, including that on the specific features of the clinical picture and treatment of this disease.

The paper describes a long-term observation and discusses the possible mechanism of leflunomide-induced clinical and morphological regression of AA-amyloidosis diagnosed at a nephrotic stage in the presence of adult-onset Still's disease.

Objective: to estimate the advantages and disadvantages of using the injectable formulation of methotrexate (MT) (Methoject (MTJ)) in rheumatoid arthritis (RA) in clinical practice. Subjects and methods. A 24-week open-label controlled randomized comparative study evaluated the therapeutic and side effects of MTJ and methotrexate tablets in RA and clarified whether MTJ treatment might be continued if its tabletted formulation was discontinued because of adverse reactions. Results and discussion. MTJ was found to be more effective than the tabletted formulation of MT and as a whole; and following 3-month therapy, more patients receiving MTJ achieved an ACR20 response. The advantage of MTJ was also retained 6 months after therapy. Higher transaminase levels were noted in 2 patients, one in each group. Switching from MT to MTJ noticeably reduced the number of adverse reactions in the majority of patients from an additional group. Conclusion. As compared to MT, MTJ used in RA patients is more effective when given in an equivalent dose, exerts a therapeutic effect more rapidly, and induces adverse gastrointestinal reactions less frequently.