According to the currently available data from large cohort studies, patients with immuno-inflammatory rheumatic diseases (IIRDs) are at increased risk of infectious complications, including influenza, compared to the general population. Vaccinations are a critical component of their care. However, data on the immunogenicity, efficacy, and safety of influenza vaccines in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) receiving modern anti-rheumatic drugs are limited. The aim of the study was to investigate the immunogenicity, efficacy, and safety of the trivalent inactivated influenza split vaccine in patients with RA, AS and PsA, observed at the V. A. Nasonova Research Institute. Materials and methods. The open prospective comparative study included 247 patients: 74 patients with RA, 62 patients with AS, 14 patients with PsA, as well as 97 people without IIRDs who comprised the control group (СG). The patients were selected over six epidemic seasons: 2016–2017, 2017–2018, 2018–2019, 2020–2021, 2021–2022, and 2022–2023. The majority of patients (78,7%) received immunosuppressive therapy at the time of inclusion in the study. The trivalent inactivated influenza split vaccine was administered in an amount of 1 dose (0,5 ml) intramuscularly against the background of anti-rheumatic therapy, regardless of the activity of the main IIRD. The level of class G antibodies to hemagglutinin (HA) of influenza A (H1N1), A (H3N2), and B viruses was determined in optical density units (OD units) using an enzyme-linked immunosorbent assay (PPDP LLC, St. Petersburg) before vaccination, 1–3 and 6 months after vaccination. The clinical efficacy and safety of the trivalent inactivated influenza split vaccine were also evaluated, including the effect on the course of RA, AS, and PsA according to the dynamics of disease activity indices. Results. After vaccination, a significant increase in the level of antibodies was observed in patients with RA, AS, and PsA. At the second visit after vaccination the level of antibodies, determined in units of optical density, to HA of influenza A (H1N1), A (H3N2) and B was significantly higher compared to baseline values. By the third visit (6 months after vaccination), there was a slight decrease in the immune response, but the level of antibodies remained significantly higher than the initial level for all strains of influenza virus, with the exception of influenza B in the group of patients with RA. During follow-up, influenza or influenza-like illness was absent in 98,6% of patients who completed the study. No negative effect of vaccination on the activity of the underlying IIRD was noted. The frequency of post-vaccination reactions in patients with IIRDs and in the СG was comparable. Conclusions. The results obtained in the study indicate sufficient immunogenicity, clinical efficacy, and safety of the trivalent inactivated influenza split vaccine in patients with RA, AS, and PsA.

Treatment algorithms for systemic sclerosis have not been completely developed. Effectivity of medications are usually used in clinical practice has a low level of evidence. Therefore, it is necessary to find a new treatment approaches for this nosological form. In the paper described clinical case of olokizumab treatment in a patient with diffuse systemic sclerosis with interstitial lung disease, polyserositis, severe microcirculatory alterations.

Infections of lower respiratory tract are prevalent among patients with immune-mediated in ammatory rheumatic diseases (IMIRD). Pneumococcus (Streptococcus pneumoniae) is still considered to be the most real causative agent of pneumonia in both the general population and the ISRD population.e article presents the frequency and risk factors for developing pneumonia in di erent IMIRD.Presented the main clinical characteristics, approaches to the treatment and prevention of pathology in the framework of pneumocystic and cytomegalovirus infections.Stressed the importance of u and pneumococcal infection vaccination in patients with IMIRD.

In modern rheumatology, comorbid infections (CIs) have a great impact on morbidity and mortality, in systemic connective tissue diseases in particular. In this connection, much attention is given to the intense introduction of different vaccines into rheumatological care. Much evidence suggests that immunization has no negative influence on the course of the underlying rheumatic disease (RD). The efficiency and safety of vaccination to prevent respiratory tract infections as the most important CIs are demonstrated. The fundamentals of the EULAR vaccination guidelines and the key areas of future investigations into this problem are presented.

The problem of comorbid infections (CI) still retains Its significance in modern rheumatology. It has significantly increased due to the introduction of genetically engineered biological products (GIBP) into practice, the use of which is associated with the growing risk of developing CIs of various nature and localization, including opportunistic (invasive mycoses, pneumonia, etc.) and an increased risk of reactivation of latent infections, primarily tuberculosis (TB). In addition, cases of severe infections (pneumonia, sepsis, bacterial arthritis, skin and soft tissue damage, etc.), including fatal cases, are recorded. This review analyzes the literature data, mainly of the last 5 years, concerning the frequency of occurrence and localization of infections in patients with rheumato-logic profile, including during treatment with GIBP. Various infections (TB, pneumonia, chronic viral hepatitis, herpes viral infections, etc.) are characterized by the importance in the tactics of treatment of these patients. The need for wider use of immunization with various vaccines (primarily against influenza and pneumococcal infection) of patients with autoimmune inflammatory rheumatic diseases is emphasized.

The problem of infectious comorbidities (ICs) remains relevant in modern rheumatology. This is due to both the presence of an autoimmune rheumatic disease and the need to use immunosuppressant drugs. The paper highlights the current aspects of main ICs (tuberculosis, pneumonia, chronic viral infections) in patients with rheumatoid arthritis (RA). It also shows the importance of measures to prevent ICs in the treatment of RA. Emphasis is placed on the importance of primarily influenza and pneumococcal vaccination in RA patients in order to reduce the incidence of lower respiratory tract infections and the risk of death from these conditions.

Aim. Study of spectrum, frequency and risk factors of comorbid infections in rheumatic diseases (RD) in the stationary contingent of patients hospitalized in the FSBI RIR named after V.A. Nasonova within 1 year.Patients and methods. The study included 245 patients with RD: 122 patients suffered from rheumatoid arthritis, 62 - systemic lupus erythematosus, 61 - systemic scleroderma. All patients were interviewed by a doctor-researcher and filled in a questionnaire. If necessary, additional information was obtained during the analysis of medical records.Results. In the spectrum of infections in patients with RD, respiratory tract and ENT infections prevailed. The frequency of serious infections (SI) during RD in the studied cohort was 23.7–38.1%. The frequency of certain infections, including SI, is influenced by the duration and variant of RD, comorbid diseases and immunosuppressive therapy.Conclusions: the data obtained indicate the importance of infections in rheumatology. A high percentage of RD exacerbation against the background of infection, the prevalence of respiratory tract infections, including SI, dictate the need for vaccine prophylaxis at the early stages of RD.

Lower respiratory tract infections occupy a leading place in patients with rheumatic diseases (RDs). Pneumococcus (S. pneumoniae) remains the most common causative pathogen of pneumonias in both the general population and patients with RDs. This review gives the frequency and risk factors of pneumonias in different RDs. It presents the main clinical characteristics and approaches to treating and preventing pneumonias due to various (including opportunistic) infections. The problem of pneumonias is very relevant in patients with RDs and it has been simultaneously extremely little developed – there are single publications on this problem are available in the Russian literature. There is a need for further investigations of its various aspects (including the efficiency of and safety of vaccination) in Russia within the uniform science program, which will make it possible to develop clinical guidelines for the management of these patients.

Differentiation between flare of a rheumatic disease (RD) and the development of infectious process is often extremely difficult due to the similarity of clinical and laboratory manifestations, as well as their lack of specificity.Objective of the study: to assess the significance of procalcitonin (PCT) test as a specific marker of generalized and local infection in patients with RD, and also to determine its role in assessing the inflammatory process activity in various RDs.Material and methods: The case records of 145 patients (101 women , 44 men, age of 3–79 years), who were undergoing inpatient examination and treatment at Nasonova Research Institute of Reumatology, were examined during the retrospective study. The serum PCT level was determined by the quantitative electrochemiluminescence method using the Cobas E 411 analyzer (Roshe, Switzerland).Results: The infectious process was diagnosed in 85 patients, the generalized one in 13 and the local one in 72. Local infections were divided into those with the light course – 41 and with the severe course – 31. In patients with generalized infection, the PCT level exceeded 2.0 ng/ml in 77% of cases and in 10.0 ng/ml in 46.2% of cases. Median (Me) PCT was 3.6 [2.26; 10.5] in the group with generalized infection. Me PKT exceeded the threshold values and amounted to 0.49 [0.19; 1.5] ng/ml in the case of a local infection with the severe course, PCT indices did not significantly differ from those of the group without infection (Me = 0.13 [0.08; 0.25] and 0.09 [0.06; 0.18 ] ng / ml, p> 0.05).with a local infection of the lungs, The maximum values of PCT in the absence of infection and with a high activity of the rheumatic process were detected in patients with Adult-onset Still’s Disease (AOSD) – Me = 0.26 [0.10; 0.61] ng/ml, moderate increase was detected in patients with systemic-onset juvenile idiopathic arthritis (JIA)– Me = 0.2 [0.14, 0.24] ng/ml, juvenile rheumatoid arthritis (JRA) – Me = 0.2 [0.1; 0.26] ng/ml, systemic lupus erythematosus (SLE) – Me = 0.19 [0.11, 0.39] ng/ml.Conclusions: Determining PCT level undoubtedly contributes to the diagnosis of generalized infections, and differential diagnosis of systemic RD from the infectious process. Further research is required to determine the PCT threshold value for various RDs.

Differentiation between flare of a rheumatic disease (RD) and the development of infectious process is often extremely difficult due to the similarity of clinical and laboratory manifestations, as well as their lack of specificity. Objective of the study : to assess the significance of procalcitonin (PCT) test as a specific marker of generalized and local infection in patients with RD, and also to determine its role in assessing the inflammatory process activity in various RDs. Material and methods: The case records of 145 patients (101 women , 44 men, age of 3–79 years), who were undergoing inpatient examination and treatment at Nasonova Research Institute of Reumatology, were examined during the retrospective study. The serum PCT level was determined by the quantitative electrochemiluminescence method using the Cobas E 411 analyzer (Roshe, Switzerland). Results: The infectious process was diagnosed in 85 patients, the generalized one in 13 and the local one in 72. Local infections were divided into those with the light course – 41 and with the severe course – 31. In patients with generalized infection, the PCT level exceeded 2.0 ng/ml in 77% of cases and in 10.0 ng/ml in 46.2% of cases. Median (Me) PCT was 3.6 [2.26; 10.5] in the group with generalized infection. Me PKT exceeded the threshold values and amounted to 0.49 [0.19; 1.5] ng/ml in the case of a local infection with the severe course, PCT indices did not significantly differ from those of the group without infection (Me = 0.13 [0.08; 0.25] and 0.09 [0.06; 0.18 ] ng / ml, p> 0.05).with a local infection of the lungs, The maximum values of PCT in the absence of infection and with a high activity of the rheumatic process were detected in patients with Adult-onset Still’s Disease (AOSD) – Me = 0.26 [0.10; 0.61] ng/ml, moderate increase was detected in patients with systemic-onset juvenile idiopathic arthritis (JIA)– Me = 0.2 [0.14, 0.24] ng/ml, juvenile rheumatoid arthritis (JRA) – Me = 0.2 [0.1; 0.26] ng/ml, systemic lupus erythematosus (SLE) – Me = 0.19 [0.11, 0.39] ng/ml. Conclusions: Determining PCT level undoubtedly contributes to the diagnosis of generalized infections, and differential diagnosis of systemic RD from the infectious process. Further research is required to determine the PCT threshold value for various RDs.

In the current context, immunosuppressive therapy of systemic rheumatic diseases (RD) is becoming more widespread. At the same time, the active use of immunosuppressors including genetically engineered biological preparations is accompanied by an increase in opportunistic infections. The latter include pneumocystic pneumonia (PPn), which is a serious complication with significant mortality in patients with RD. However, given the heterogeneous data on the risks of specific RH and some or other immunosuppressive therapy, the development of a evidence-based comprehensive guide on the prevention of PPn in rheumatology is currently not possible. Specific guidelines for practical physicians can serve as algorithms of PPn prevention published by different authors, which are sure to be further followed-up (or processed) as new data are accumulated within the framework of the problem under consideration.

Objective: to evaluate the safety and effectiveness of vaccination with trivalent split virion influenza vaccine in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS), estimate the effect of vaccination on rheumatoid disorder (RD) activity and influenza and influenzalike illnesses morbidity.Materials and methods. The study included 86 patients (58 females and 28 males aged 22–82 years) with RDs (52 patients with RA and 34 patients with AS), as well as 40 subjects without RD (control group). At the time of study inclusion, all patients were receiving drug therapy. Duration of RD varied from 2 months to 46 years. The Vaxigrip vaccine containing the currents trains of the flu virus for 2016–2017 season or 2017–2018 season was administered subcutaneously as 1 dose (0.5 ml) with continuing antirheumatic therapy. The main control stages were visits 1, 3, and 6 months after vaccination. During the visits, standard clinical and labtests, clinical examination with disease activity evaluation were performed.Results. In 98 patients, vaccination tolerability was high, no post vaccination reactions were observed. In 20 cases, pain, swelling, and hyperemia of the skin 2 cm in diameter at the point of vaccination were observed; in 8 cases, low-grade fever, myalgia, discomfort, headache were observed. No RD flares or development of new autoimmune disorders were diagnosed during the follow-up period. No cases of influenza or influenza-like illnesses were registered during the follow-up period.Conclusion. The obtained data demonstrate high tolerability, clinical effectiveness of trivalent split virion influenza vaccine in patients with RA and AS.

Chikungunya fever (CF) is a feral nidal viral disease with the mechanism of transmission by Aedes mosquitoes. All increasing migration flows have carried brought the infection to new regions and, consequently, expanded the disease area, including European countries. CF is of undoubted interest for rheumatologists primarily due to the development of severe joint syndrome (arthralgia/arthritis) developing at all stages of the disease. This review gives data on the etiology, pathogenesis, and epidemiology of CF. It describes in detail the clinical presentations of this disease, methods for its diagnosis and differential diagnosis, as well as main approaches to its therapy.

Nowadays, HIV infection remains one of the major threats to global public health. The clinical signs of HIV infection are extremely diverse and associated with many, including rheumatic diseases. This review examines the issue of osteoarticular disorders in HIV positive patients. The article presents a detailed clinical description of individual nosological forms (HIVassociated arthritis, reactive arthritis, psoriatic arthritis, etc.) and considers the issues of differential diagnosis of these diseases. Modern approaches to the treatment of inflammatory joint diseases in HIV infection, including genetic engineering biological preparations are analysed.

Invasive mycoses are becoming a more relevant problem in modern rheumatology. There are difficulties in the lifetime diagnosis and treatment of mycoses in patients with rheumatic diseases. The significance of this issue increases considerably due to the active clinical introduction of biological agents. The paper provides general information on the clinical presentation, diagnosis, and therapy of the most common mycoses.

Currently, differential diagnosis of systemic bacterial infection and active rheumatic process remains a challenging problem in rheumatology. In the review, current data on the role of procalcitonin biomarker in diagnosis and differential diagnosis of rheumatic diseases (RD) and infectious pathology are presented. In particular, some authors recommend procalcitonin (PCT) test as a marker of bacterial infection in bones and joints at levels above 0.5 ng/ml; at PCT level below 0.3 ng/ml, infection can be ruled out. In patients with microcrystalline arthritis, data on the significance of PCT for differential diagnosis are contradictory. PCT level doesn’t correlate with systemic lupus erythematosus activity and is elevated only during bacterial infection proportionally to its systematicity. In some studies, elevated PCT level was observed in ANCA-associated vasculitis with high activity without bacterial infection. It was shown that in 80 % of adults with Still’s disease, PCT level was higher than the threshold value even without infection. For patients with RD hospitalized in intensive care units, PCT clearance is a more informative predictive characteristic than its level, regardless of the cause of PCT elevation (infection, injury, severe organ damage, etc.); slowdown of its decrease is a factor of poor prognosis and is associated with higher mortality. At the same time, PCT level positively correlates with the SOFA score in presence of bacterial infection. For some rheumatic diseases, the threshold PCT value at which the test has optimal sensitivity and specificity is yet to be established. Nonetheless, PCT should be evaluated in relation to the clinical picture and data of additional examinations. The effect of various therapy methods used in rheumatology on PCT level requires further research.

The problem of coinfections that are due to both a rheumatic disease (RD) itself and the need to use immunosuppressive drugs deserves apparent attention in modern rheumatology. Coinfections substantially affect morbidity and mortality rates, especially in diffuse connective tissue diseases. The data available in the literature on the above subject matter suggest that vaccination is a powerful method for prevention of infectious diseases that are the most important problem for patients with RD.