The article presents 3 cohorts with early rheumatoid arthritis in patients aged 50 years and older with a disease duration from 1.5 months to 1 year. To establish a diagnosis, the classification criteria of its period were applied to each of the cohorts: to the 1st - the 1958 ARA criteria, to the 2nd – the 1987 ARA criteria, to the 3rd - the 2010 ACR / EULAR criteria. Along with changes in the criteria diagnostic methods improved, many qualitative laboratory indicators were replaced by a quantitative equivalent; new disease markers (including ACPA), improved imaging methods, changed treatment strategies, genetically engineered drugs, numerous analogues of the original drugs appeared. Сonflicting opinions about the course of RA in older age periods have been published in the literature consistently. During application of the 1958 classification criteria, the prevailing opinion was that these patients had a more favorable course; as a more hardline approach to RA diagnosing appeared, a growing number of supporters of its more severe course appeared. In the research the author tries to answer the question whether the course of the disease in the older age groups has changed at the earliest time from its beginning by comparing three cohorts of different time periods. The data obtained are discussed.

В настоящее время в ревматологии накапливается всё больше данных о факторах, влияющих на эффективность генно-инженерных биологических препаратов (ГИБП) и не существует общепринятого алгоритма по ведению пациентов с резистентностью к стандартной терапии. Представлено описание 3 пациентов с анкилозирующим спондилитом (АС), наблюдавшихся в 2011 – 2019 гг. в ФГБНУ НИИР им. В.А. Насоновой. У всех больных отмечалось тяжелое течение АС с высокой клинико – лабораторной активностью, наличием внесуставных проявлений и неэффективностью трех и более ГИБП. Всех пациентов объединяют следующие признаки: мужской пол, ранний дебют заболевания, высокая клинико-лабораторная активность и наличие внесуставных проявлений, таких как увеит и псориаз.

Objective: to analyze therapy with rituximab (RTM) in real clinical practice according to the data available in OREL registry of patients with active rheumatoid arthritis (RA). Subjects and methods . The analysis included 349 patients. All the patients received RTM: 340 – the original drug (MabThera®) and 9 – the biosimilar Acellbia®. 263 patients (75.4%) received RTM in combination with disease-modifying anti-rheumatic drugs (DMARDs) and 86 (24.6%) – RTM as monotherapy. Results and discussion . Of the 349 patients included in the analysis, 272 (77.9%) patients received RTM as the first biologic agent (BA) (263 patients were treated with the original drug and 9 – with the biosimilar) and 77 (22.1%) patients had previously used the BA. The majority of patients (n=205 (58.7%)) received three or more; 109 (31.2%) patients – one, and 35 (10%) – two RTM courses of RTM therapy. RTM caused a significant reduction in disease activity just after the first therapy course and in the levels of acute-phase reactants (C-reactive protein (CRP) and ESR); after the fifth therapy course, median CRP concentration decreased by 1.4 times and amounted to 7 [1.2; 17.9] mg/l and that of ESR reduced by 1.8 times and was 10 [5; 20] mm/hr (p<0.05). Conclusion. The analysis of RTM therapy in RA patients in real clinical practice demonstrated that in most cases RTM was given as the first BA, in combination with DMARDs, the main agent of which was methotrexate. The use of RTM was accompanied by a significant reduction in disease activity and in the serum levels of acute-phase reactants and autoantibodies.

Ankylosing spondylitis (AS) is a systemic inflammatory disease involving not only the skeleton, but also other organs. The data on the frequency and clinical significance of extraskeletal manifestations are contradictory. Objective: to assess the frequency and severity of extraskeletal manifestations (ESMs) of AS in the authors' own clinical practice. Subjects and methods. 452 patients (363 men and 89 women) with AS fulfilling the 1984 relevant New York criteria were examined at the V.A. Nasonova Research Institute of Rheumatology in 2005 and 2014. The patients' median age was 31.5 [24; 41] years; median disease onset age, 19 [15; 23] years; disease duration, 11 [7; 18] years; HLA B27 was identified in 442 (97.7%) patients. In addition to standard laboratory and instrumental examinations, transthoracic echocardiography was performed in 172 patients. Rehberg's test, IgA test, histological examination of subcutaneous fat tissue or duodenal mucosa for amyloid, and renal ultrasound were made if there were urinary abnormalities and elevated creatinine levels. If indicated, there were consultations by an ophthalmologist with an appropriate instrumental examination (with evidence of uveitis in the history), a dermatologist, a nephrologist, an urologist, a gastroenterologist, and a endoscopist. Uveitis, cardiac involvement (conduction disturbance, aortic and valvular changes), inflammatory bowel disease (IBD), glomerulonephritis, and psoriasis were borne in mind as ESMs. The absolute number and percentage of patients having any ESM over the follow-up period were estimated. The number of exacerbations per year and that of complications were taken into account when evaluating uveitis; the magnitude of valvular regurgitation and the presence of prosthetic valves and a pacemaker were considered when assessing cardiac damage; the total body surface area (BSA) and the psoriasis areas and severity index (PASI) were estimated in psoriasis; the presence and stage of chronic kidney disease (CKD) and/or macrohematuria were kept in mind in nephropathy; when evaluating IBD, the Harvey–Bradshaw index (HBI) was determined on the basis of a stool frequency, the presence of blood in the stool, abdominal pain, and general well-being. Results and discussion. ESMs were detected in 218 (48%) of the 452 patients. Uveitis was present in 140 (30%) patients; in one-fourth of them, it relapsed frequently: three or more exacerbations per year and more than 10 during the disease; 41 (29%) patients had uveitis complications accompanied by visual impairment. Cardiac conduction disturbance was revealed in 61 (13%) patients. Five of them underwent pacemaker implantation. 71 (41.2%) patients were found to have aortic and valvular changes, including aortic root dilatation/thickening in 60 (34.8%) patients and aortic/mitral valve leaflet thickening in 63 (36.6%). Grades 3 and 4 valvular regurgitation was noted in 10 (5.8%) patients; valve replacement was carried out in 9 (5.2%) cases. Nephritis was diagnosed in 16 (3.5%) patients, 4 of them had Stage 2 or above of CKD. Psoriasis was present in 17 (3.7%) patients; 2 of them had severe psoriasis (BSA >10%). IBD (ulcerative colitis or Crohn's disease) was diagnosed in 16 (3.5%) patients, including 4 who showed a severe course. 79 (36%) patients were observed to have a concurrence of two or more ESMs; that of uveitis and heart disease was most commonly seen. Conclusion. ESMs are observed in nearly half (48%) of the patients with AS and can be concurrent; the most common ESMs of AS are uveitis, aortic root and heart valve lesions, and cardiac conduction disturbance. ESMs worsen the course and prognosis of AS.

The paper gives recommendations for the drug therapy of axial spondyloarthritides, which have been developed by the Spondyloarthritis Study Group of Experts. The recommendations describe the patient management tactic in the most common clinical situations, which is aimed at maximizing the efficacy and safety of treatment.

A work classification of ankylosing spondylitis is presented including such novel concepts as the stage of the disease (instead of sacroiliitis), extra-axial and extra-skeletal manifestations. Modern approaches to the evaluation of disease activity are described Extensive explanations of these notions are presented together with the recommendations on formulation of diagnosis. The advent of new and more eficacious methods of visualization as well as more sensitive and specific criteria for inflammatory nature of back pain are considered The authors modified the traditional criteria for ankylosing spondylitis and developed their version to be verified in clinical practice in this country.

Objective. To assess the efficacy and safety of infliximab in pts with ankylosing spondylitis (AS) in an open 56-week prospective study. Material and methods. Thirty pts (19 male) fulfilled the modified New York criteria of AS with active disease (BASDAI and spinal night pain >40) received intravenous infusions of infliximab (5 mg/kg) at weeks 0, 2, 6, and every 6-8 weeks thereafter. 17 pts had also arthritis of peripheral joints and 20 pts had enthesitis. Median age of the pts was 31 (range: 1940) years, median duration of AS was 9.5 (range: 4-19) years. HLA-B27 was found in 29/30 pts. Results. After 3 infusions of infliximab (at week 14) reduction of BASDAI >50% was achieved in 28 pts (93%). 29 (97%) pts had 50% improvement (according to ASAS response criteria), 26 (87%) pts ASAS70 improvement. The treatment also provided statistically significant improvement (median and 25-75 quartile range) of the following measures: global pain (VAS, 0-100 mm) from 66.3 (56-71.3) to 2.5 (1.1-4.9); spinal night pain (VAS, 0-100 mm) from 65.5 (55.5-71.8) to 0 (0-3); lumbal flexion (cm) from 3.4 (24) to 4 (3-5); swollen joint count from 4 (1-7) to 0 (0-2); BASFI (0-100) from 60 (47.267.9) to 6.4 (2.1-11.2); p

AIM:To study efficacy and tolerance of 1-3-day intravenous therapy with high dose glucocorticoids in patients with active ankylosing spondylitis (AS).MATERIAL AND METHODS:Methylprednisolone (MP, n = 33) and dexamethason (DM, n = 13) were given to 46 patients with active AS (median BASDAI 47; coxitis was in 37 patients, arthritis of other peripheral joints--in 30 patients). MP and DM were given as 1-3 intravenous infusions, in single doses equivalent to 500-1000 mg of MP. Total doses were 500-3000 mgfor MP and 120-360 mg for DM. Intervals between the infusions were from I to 8 days.RESULTS:An immediate positive effect was seen in all the patients. Significant reduction of AS activity (lowering of BASDAI by 50% and more) was registered in 22 (48%) patients. In accordance with ASAS criteria, 20% improvement occurred in 35 (76%) patients, 50%--in 25 (54%). A significant decrease was seen in the number of joints with inflammation, volume of exudate in hip joints, ESR, C-reactive protein level, functional condition of the patients (BASFI), spinal mobility. Side effects were observed in 26 of 46 (56%) patients. Severe side effects manifested in 17% cases. Efficacy and tolerance of MP and DM were comparable. The immediate response to therapy and side effect rate were unrelated to single and total doses of glucocorticoids. The response persisted for 3 months in 41% patients, a significant effect was observed for 3 months in 9% patients.CONCLUSION:Short-term intravenous therapy with high-dose glucocorticoids is highly effective in the majority of patients with active AS and well tolerated. A short-term effect was seen both for spondylitis and arthritis of peripheral joints, including coxitis, but the effect is not long-lasting.