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The problem of infectious endocarditis (IE) still retains its importance due to high mortality rates and the development of severe complications. Modern IE is a polyethological disease, the occurrence and development of which can be caused by pathogens that make up an extremely extensive list, which is updated almost annually. At the same time, serious obstacles standing in the way of effective antimicrobial therapy are both the increasing resistance of IE pathogens to antibiotics and the increasing etiological role of infectious agents that were previously very rare. This article presents the basic principles of treatment and prevention of IE, taking into account the latest recommendations of the experts of the European Society of Cardiology in 2023.

Patients with immune-mediated inflammatory rheumatic diseases (IIRD) are more likely to develop herpes zoster (HZ) than individuals in the general population. Live attenuated vaccines and inactivated recombinant vaccines with adjuvant are available to prevent the disease and its complications. Live attenuated vaccine can be used in patients with IIRD if certain conditions are met, although these cannot always be fulfilled. The advantage of the inactivated recombinant adjuvant vaccine is that it can be used against a background of anti-rheumatic therapy. The review analyzes foreign studies on the safety, immunogenicity and efficacy of recombinant adjuvant vaccine against HZ in patients with IIRD.

The problem of infective endocarditis (IE) remains relevant due to the high mortality rate and the development of severe complications. IE is a polyetiological disease, which can be caused by an extremely extensive list of pathogens, which is replenished almost annually. At the same time, effective antimicrobial therapy is made considerably more difficult by the increasing resistance of IE pathogens to antibiotics and the growing etiological role of infectious agents that were previously very rare. Part II of the article presents the basic principles of treatment and prevention of IE, considering the latest recommendations of the European Society of Cardiology 2023.

The problem of infective endocarditis (IE) remains relevant due to the high mortality rate and the development of severe complications. IE is a polyetiological disease, the occurrence and development of which can be caused by an extremely extensive list of pathogens, which is replenished almost annually. The pronounced clinical polymorphism of IE determines the importance of its early diagnosis, including the use of new medical technologies. Timely informing physicians about the modern principles of monitoring of patients with IE is of great practical importance. Part I of the article describes the clinical features, basic principles of diagnosis and differential diagnosis of IE, taking into account the recommendations of the European Society of Cardiology 2023.

Fatigue is a persistent and debilitating feeling of tiredness that limits the ability to perform daily activities and is a common and difficult-to-treat condition in patients with rheumatic diseases (RD). Fatigue is a major challenge for the physician. However, methods to treat it have not yet been developed, as fatigue is usually considered an insignificant background condition. This article provides an overview of the 2023 EULAR recommendations, which outline the guiding principles and strategy for the management of fatigue in patients with RD. The EULAR recommendations are based on an understanding of fatigue as a complex condition that requires an individualized approach in choosing the correction methods. It is important that the assessment of fatigue becomes part of the routine practice of rheumatologists and other physicians. Patient education recommendations emphasize the importance of an individualized approach tailored to the needs of the individual, including optimizing physical activity and psychoeducational interventions.

According to the World Health Organization (WHO), worldwide, annual influenza epidemics lead to approximately 3–5 million cases of severe forms of the disease and 250–500 thousand deaths. The problem of the course and outcomes of influenza is also relevant for patients with immunoinflammatory rheumatic diseases, including spondyloarthritis (SpA). However, data on the immunogenicity, efficacy and safety of influenza vaccines in patients with SpA are limited.The aim of the work was to study the immunogenicity, efficacy and safety of the trivalent inactivated influenza split vaccine in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA), observed at the V.A. Nasonova Research Institute of Rheumatology.Materials and methods. 94 people were included in the study: 28 patients with AS, 14 patients with PsA, 52 patients in control group (СG) without immunoinflammatory rheumatic diseases. Vaccination with a trivalent inactivated influenza split vaccine was carried out over three consecutive epidemic seasons: 2020–2021, 2021–2022, 2022–2023. The majority of patients (71,4%) received immunosuppressive therapy. 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 IVR. The level of antibodies (AT) of class G to hemagglutinin (HA) of influenza A (H1N1), A (H3N2) and B viruses was determined using enzyme immunoassay systems manufactured by PPDP LLC (St. Petersburg, Russian Federation) before vaccination, 1–3 (on average, 1,6±0,8) and 6 months after it. The clinical efficacy and safety of trivalent inactivated influenza split vaccine were also evaluated, including the effect on the activity of AS and PsA according to the dynamics of BASDAI and DAPSA indices.Results. At the second and third visits after vaccination the level of AT, determined in units of optical density, to HA of influenza A (H1N1), A (H3N2) and B was significantly higher compared to baseline values. During follow-up, influenza or flu-like disease according to WHO criteria were absent in 37 patients. In general, there was no negative effect of vaccination on the activity of the underlying disease. The frequency of postvaccinal reactions in patients and in СG was comparable.Conclusions. The obtained results of the study indicate sufficient immunogenicity, clinical efficacy and safety of trivalent inactivated influenza split vaccine in patients with AS and PsA.

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.

Patients with rheumatic diseases infected with hepatitis B virus (HBV) are difficult to manage not only due to the presence of risk factors for the development and rapid progression of liver cirrhosis, but also due to the likelihood of reactivation of this infection. Despite the successes achieved in the fight against HBV, the virus cannot be completely defeated due to the presence of hidden forms of the disease, escaping the field of vision of a rheumatologist and an infectionist. Based on the results of the analysis of current publications, the paper presents the rationale for a complete immunological screening of patients with rheumatic diseases when prescribing antirheumatic therapy. The issues of the role of COVID-19 in the exacerbation of chronic viral hepatitis B, antiviral prevention and monitoring are discussed, the classification of antirheumatic drugs according to the risk of HBV reactivation is presented.

Currently, methotrexate (MT) remains one of the immunosuppressive drugs most commonly used in rheumatology. However, its effect on the immunogenicity of vaccines has until recently been studied only to a limited extent, which has led to the lack of clear recommendations for the use of MT during vaccination. Significant progress was made during the COVID-19 pandemic due to the dynamic development of vaccine research, including in patients with immuno-inflammatory rheumatic diseases. The review presents data on the effect of MT on the immunogenicity of vaccines against influenza, pneumococcus, herpes zoster, tetanus/diphtheria/pertussis, yellow fever and COVID-19 (including humoral and cellular responses) in rheumatological patients. The necessity of observing certain time intervals during vaccination in the case of MT use has been demonstrated. The potential mechanisms by which MT influences the immunogenicity of vaccines are presented. The importance of further clinical studies is emphasized in order to assess the effect of MT therapy on the vaccine response and to develop methods for its optimization.

In modern conditions, patients with immuno-inflammatory rheumatic diseases (IIRD) are at significant risk of influenza, pneumococcal and herpes viral infections, as well as COVID-19, in some cases fatal. The most effective way to prevent infectious diseases and reduce mortality from them is vaccination, which is recommended in the inactive phase of IIRD. However, a number of patients with IIRD have a refractory course of the disease, and achieving remission in them turns out to be a difficult task, and therefore the problem of vaccination of such patients against the background of an active inflammatory process is very relevant. The review analyzes data on the use of vaccine prophylaxis for the above infections in the active phase of IIRD. In the vast majority of cases, vaccination was safe and did not lead to an exacerbation of IIRD or the development of new autoimmune phenomena.

The aim – to study risk factors for severe COVID-19 in patients with rheumatic diseases (RD).Patients and methods. The study included medical histories of 464 patients with RD who were admitted at the V.A. Nasonova Research Institute of Rheumatology from September 27, 2021 to April 26, 2023Results. Age over 60 years, hypertension, obesity, lung disease, chronic kidney disease, coronary heart disease, diabetes mellitus, acute cerebrovascular accident or a history of pulmonary tuberculosis increase the risk of hospitalization in patients with RD with COVID-19 by 3–5 times. In addition, with an increase in the number of concomitant diseases, an increase in the risk of hospitalization was noted by 2–6 times. Taking glucocorticoids, including at a dose of ≥10 mg per day for prednisolone, mycophenolate mofetil and rituximab, leads to an increase risk of hospitalization by 1.5–4.5 times, while patients taking hydroxychloroquine or tumor necrosis factor α inhibitors was more often required outpatient treatment.Conclusions. It has been established that older age, the presence of comorbid pathology and the use of glucocorticoids, including at a dose of ≥10 mg per day for prednisolone, mycophenolate mofetil and rituximab, are risk factors for severe COVID-19.