The article presents a description of two own observations of the development of acute urate nephropathy in women with asymptomatic hyperuricemia. Clinical data and the results of additional laboratory and instrumental studies are presented; in one of the observations, the morphological picture of intravital biopsy material against the background of prolonged use of diuretics is described. The second case characterizes tophus kidney damage (according to the pathological examination data) without characteristic clinical manifestations of gout in vivo. The authors draw attention to the need to study serum uric acid levels in all cases of acute kidney injury.

The JAK inhibitor tofacitinib (TOFA) blocks the intracellular signaling pathway that activates the synthesis of cytokines and mediators involved in the development of pain and central sensitization (CS), which determines the rapid analgesic effect. However, it is not clear how pain reduction is associated with achieving low activity in rheumatoid arthritis (RA).The aim of the study was to assess the relationship between the early clinical response to tofacitinib and a decrease in rheumatoid arthritis activity after 3 and 6 months.Material and methods. The study group consisted of 88 RA patients (age – 53±11.5 years; 79.3% of women) who received basic anti-inflammatory drugs (59.5% – methotrexate, 19.8% – leflunomide) and who were prescribed TOFA in a dose 10 mg/day. Seropositivity for rheumatoid factor was 89.8%; the value of the DAS28 index is 5.2±1.2. The severity of pain was assessed using the Brief Pain Inventory questionnaire, the neuropathic component of pain (NCP) – using the PainDETECT questionnaire, signs of CS – using the Central Sensitization Inventory (CSI) questionnaire in the early stages after the administration of TOFA, RA activity – using the DAS28-CRP index after 3 and 6 months.Results. The mean severity of pain at baseline was 5.3±2.0 on the visual analogue scale (VAS); 51.1% of patients had signs of CS (CSI>40), 15.9% had NCP (PainDETECT>18). 7 days after the start of therapy, there was a significant decrease in pain – to 4.1±1.8 according to VAS (p<0.05) and CS – 40.4±13.5 to 36.5±12.5 according to CSI (p=0.01). After 28 days, the effect was even more significant: the level of pain according to the VAS was 2.8±1.6 (p=0.000), the NCP decreased from 11.8±5.6 to 6.8±3.1 (p=0.000), CS – up to 31.6±13.9 (p=0.000). The value of the DAS28-CRP index after 3 and 6 months was 3.7±1.3 and 3.6±1.2, respectively. The number of patients with pain relief ≥50% after 28 days was 59.9%, low RA activity after 3 months. (DAS28-CRP≤3.2) was acieved in 64.4% of patients. There was a clear correlation between the number of patients with a pain reduction of ≥50% at 28 days and the number of patients who achieved low RA activity at 3 and 6 months. (rS=0.548, p=0.000 and rS=0.790, p=0.000). 6 patients dropped out of the study due to inefficiency or social reasons. No serious adverse reactions were noted.Conclusions. The use of the JAK inhibitor TOFA allows achieving a quick analgesic effect and reducing the signs of CS. An early clinical response to TOFA (pain relief) predicts a decrease in RA activity after 3 and 6 months of therapy.

The article presents a description of two own observations of the development of acute urate nephropathy in women with asymptomatic hyperuricemia. Clinical data and the results of additional laboratory and instrumental studies are presented; in one of the observations, the morphological picture of intravital biopsy material against the background of prolonged use of diuretics is described. The second case characterizes tophus kidney damage (according to the pathological examination data) without characteristic clinical manifestations of gout in vivo. The authors draw attention to the need to study serum uric acid levels in all cases of acute kidney injury.

The diagnosis of a disease accompanied by febrile syndrome presents special problems in clinical practice. The traditional diagnostic algorithm in this case involves the exclusion of infections, cancer, and rheumatic diseases. The causes of fever can be severe types of rheumatoid arthritis, systemic vasculitis, and diffuse connective tissue diseases, as well as rare diseases, the difficulty of diagnosis of which is due to low awareness of the disease and the absence of specific clinical, laboratory, and instrumental signs. These also include relapsing polychondritis (RPC) in particular. RPC is a rare systemic inflammatory disease of cartilage tissue, which leads to its structural changes resulting in complete destruction. Cartilages of the acoustic apparatus, nose, trachea, and joints are mainly affected. The severity of cardiovascular injury in RPC has recently been emphasized. This disease is observed with equal frequency in men and women, primarily at the age of 40–60 years, predominantly in white people, but it also occurs in other populations. The etiology of RPC is unknown. There are no pathognomonic laboratory and instrumental tests for the diagnosis of RPC. A unified approach to treating this condition has not been elaborated. The available data on the pathogenesis, various clinical manifestations and treatment options of the disease are analyzed. The authors’ own observations of RPC are depicted.

The based on examination of 78 patients with systemic scleroderma and secondary Raynaud's phenomenon using the method of laser Doppler flowmetry (LDF) («ЛАЗМА» Russia) was offer the method for objective estimation of microcirculatory abnormalities. It was concluded that the more informative indexes of LDF are vasomotion activity, relation between high and low frequency oscillation, the reaction of capillars in occlusal test, endothelial dependence component and reduction of blood flow after nitroglycerin. The authors proposed the predictable criteria for the efficiency of vasodilatation therapy. Proposed method may used for measuring of heaviness Raynaud's phenomenon in patients with systemic sclerosis and for diagnose adecquate of vasodilatations treatment.