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Currently, the list of microorganisms that have a possible connection with the development of rheumatoid arthritis continues to be updated. The role of not only traditional pathogens, but also representatives of conditionally pathogenic microflora is being actively studied. A number of domestic and foreign works demonstrate a high degree of Helicobacter pylori infection in patients with rheumatic diseases, including rheumatoid arthritis.The aim of the present study is to identify the frequency of detection of Helicobacter pylori infection in patients with rheumatoid arthritis and in adult residents of the city of Tula.Material and methods. The study included 3288 residents of Tula who do not have rheumatic diseases, and 119 patients with rheumatoid arthritis. To detect the infection, FEGDS was performed according to the generally accepted method with the taking of biopsies of the mucous membrane of the antrum and the stomach body, followed by verification of Helicobacter pylori using the Helpil-test test system.Results. According to the results of the data on the infection rate of residents of Tula without rheumatic diseases (n=3288), the largest percentage of infected (78.8%) was detected by an invasive method – express diagnosis of urease activity of the biopsy. The detection rate using a respiratory ammonia test and serological method was lower and amounted to 51.1 and 49.3%, respectively. In total, H. pylori was detected in 1692 people, which was 51.46%. Among patients with rheumatoid arthritis, Helicobacter pylori infection was 81.5%. Signs of damage to the mucous membrane of the upper gastrointestinal tract were often detected: superficial and subatrophic gastritis, single erosions.Conclusions. 1. Based on the study, it was found that the infection rate of Helicobacter pylori in patients with rheumatoid arthritis is at a fairly high level, not significantly different from that in residents without rheumatic diseases, when examined by an invasive method – express diagnosis of urease activity of the biopsy (81.5% and 78.8%, respectively). 2. Among patients with rheumatoid arthritis, there was a tendency to increase the frequency of infection with age and peak values in older age groups (r=0.37; p˂ 0.05). 3. The frequency of detection of erosive and ulcerative lesions of the gastrointestinal tract in infected and uninfected Helicobacter pylori patients with rheumatoid arthritis significantly differed (42.2 and 13.6%) (p=0.03).

To date, there are numerous studies on the effect of COVID-19 on the course of autoimmune rheumatic diseases and the value of vaccination in preventing this dangerous viral infection.Objective: to assess the effect of coronavirus infection on the course of rheumatoid arthritis (RA), the severity of infection, the effect of current baseline therapy on infection outcomes, and the role of vaccination against COVID-19.Patients and methods. 134 patients with a reliable diagnosis of RA were interviewed and their outpatient records analysed during the pandemic period from January 2020 to July 2021.Results. Most of the patients were in the older age group (62.7 years on average), had an average disease duration of 13 years, low to moderate RA activity, comorbidities including arterial hypertension, excess body weight, type 2 diabetes mellitus, etc. All patients received synthetic basic anti-inflammatory drugs (BАID) and glucocorticoids (GC). Thirtyseven (27.6%) patients were vaccinated with the Sputnik V vaccine. Their adverse events were represented by soreness at the injection site (n=6) and transient flu-like syndrome (n=6). Worsening of joint syndrome was reported by 1 patient. COVID-19 was suffered by 43 patients, none of whom were vaccinated. 7 patients were hospitalized, 3 patients died (all had severe comorbidities). In the post-infection period, weakness (64%), memory impairment (48.7%), reduced ability to work (38.5%) persisted for a long time (42 days on average), which was due to the long withdrawal of BАID.Conclusion. No exacerbations of the disease were noted in those vaccinated with Sputnik V. COVID-19 was detected in 43 (32.1%) patients, 7 of whom required hospitalization and 3 died. Exacerbation of RA in the post-infection period was associated with prolonged withdrawal of BАID.

Hematidrosis is a rare disease. Isolated cases are described in the literature, which makes it impossible to study the etiology and pathogenesis of the disease. The most convincing are the assumptions about the role of emotional stress in the clinical manifestations of the disease. The author presents his own 2-year observation of a girl who periodically had bleeding from the nose and ear canal.

Objective : to assess trends in the overall and primary incidence of rheumatic diseases (RD) from by visit rates in Russia in 2015–2016. Material and methods . The incidence rates were analyzed on the basis of the data presented in the reports of the Ministry of Health of Russia on adult mortality rates in 2015 and 2016. Results and discussion . The analysis of adult morbidity rates associated with musculoskeletal diseases (MSDs) revealed a certain downward trend in Russia over 2015–2016. The total number of registered patients with this pathology in 2016 amounted to 16.6 million people, which were 266 thousand people less than in 2015. The primary incidence of MSDs showed a decline by 55 thousand people in this period. The reports of the Ministry of Health indicate that the entire group of patients with MSDs in the section «Rheumatology» has data on six nosological entities: rheumatoid arthritis (RA), reactive arthropathies (RAP), spondylopathies (SP), systemic connective tissue disease (SCTD), osteoarthritis (OA), and osteoporosis (OP). In the RD group OA accounted for the highest incidence rates (4,350,465 cases in 2015 with some reduction (4,285,464 cases) in 2016). In 2015 and 2016, the incidence of RA was 50,905 and 76,823 cases; that of SP was 110,855 and 115,442 cases; that of RAP was 50,905 and 76,823 cases; that of SCTD was 62,265 and 58,276 cases; that of OP was 155.107 and 155,624 cases, respectively. psoriatic arthritis (PsA) accounted for the lowest incidence rates (18,069 and 19,229 cases). The Russian Federation annually registers more than 600 primary cases of OA per 100,000 adult population; less frequent were RA (27.2), SP (18.2), OP (10.2), and RAP (13.5); SCTD and PsA were much less diagnosed (5.9 and 2.84, respectively). Noteworthy are significant variations in the overall and primary incidence in both federal districts and one federal district, making it difficult to attribute only to climatic and geographical factors. This is most likely to be associated with a shortage of trained rheumatologists in individual subjects of the Russian Federation. In addition, it is necessary to monitor the correctness of the diagnosis and its encoding in accordance with ICD-10.

Ankylosing spondylitis (AS) is a chronic systemic disease of the axial skeleton. Recently, there has been increased interest among practitioners and researchers in AS. Because of difficulties in conducting epidemiological surveys studying statistical data on its prevalence and patient mortality is of great importance. It permit introduction of necessary corrections into organization of medical care to patients on the basis of analysis of the situation in the region. Objective: to study the trend and validity of data on AS prevalence and patient mortality in the adult population of the Tula Region versus the Russian Federation. Subjects and methods. The investigators used the 2002–2010 statistical guidelines “Prevalence of diseases in adult population of Russia” by the Ministry of Health of Russia; the 2006–2010 federal statistical inquiry forms No. 14 in the Tula Region and the Russian Federation; the European hospital database; the 2000–2011 mortality databases in the Tula Region, which had been obtained by the automated mortality registration systems, which contained 373,997 records and included all margins of “Medical Death Certificates”. Results and discussion. In the Russian Federation, overall prevalence of AS per 100,000 adult population increased from 27.6 in 2002 to 34.4 in 2010 (the increment was 24.6%) while in the Tula Region its trend was unstable in this period. Incidence of AS here decreased by 31.8% from 2002 to 2010; in Russia its increment was 51.6%. From 2000 to 2011 in the Tula Region AS was registered as one of the causes of death in 29 cases. Conclusion. To plan measures aimed at improving the quality of medical care to AS patients, it is necessary to expand a comprehensive study of AS prevalence as well as outpatient and inpatient mortality from AS

The incidence of major rheumatic diseases was analyzed inRussia's adult population in 2012–2013 on the basis of the statistical reports of the Ministry of Health ofRussia(Form No. 12). Among the adult population ofRussia, the overall incidence of acute rheumatic fever (ARF) decreased by 11.6% (from 1666 to 1474 cases). No case of ARF was registered in 11 of the 83 subjects of the Federation in 2013. The inci- dence rates per 100,000 adult population compared toRussia's ones were higher in theRepublicofIngushetia(21.0%), theChechen Republic(13.2%), and the Chukotka Autonomous District (26.2%). All cases of ARF were first notified. The overall incidence rates of chronic rheumatic heart diseases amongRussia's adult population tend to reduce slightly [by 5.3% (from 182,286 to 172,687 cases)]. In the period in question, the total number of patients with musculoskeletal diseases (MSD) slightly rose. The bulk of rheumatic patients from the MSD group are more than 4 million patients with osteoarthritis (OA), half of them (2,454,563) being those who are older than able-bodied age. The incidence of OA tends to increase in all Federal Districts (FD). The most common joint inflammatory diseases are rheumatoid arthritis (RA) (286,000 cases), spondylopathies (90,000 cases), and osteoporosis (152,000 cases). The incidence rates of MSD per 100,000 adult population are higher in the North-Western (19,397.7), Volga (16,552.6), and Siberian (16,133.4) FD thanRussia's mean rate (14,205.5). There were somewhat higher incidence rates of RA per 100,000 population in 2013 than in 2012 (241.4 and 245.6, respectively). The rates in the North-Western, Ural, Far Eastern, and Volga FDs are higher than the mean Russian ones. In 2011, the rubric of «Ankylosing spondylitis» (AS) was replaced by that of «Spondylopathies» that, besides AS (ICD-10 M45), encompasses other inflammatory spondylopathies (M46), including infectious one, which does not allow single out the spinal inflammatory diseases under a rheumatologist's competence. InRussia, there were 39,800 patients with AS in 2010 and as many as 89,000 patients with spondylopathies in 2013. The incidence of systemic connective tissue diseases (SCTD) remains rather stable. Unfortunately, SCTDs include different nosological entities (sys- temic lupus erythematosus, systemic sclerosis, systemic vasculitides, etc.), which cannot refine trends in the incidence of specific diseases. In a number of the Federation's subjects, the incidence rate of reactive arthritis (ReA) is higher thanRussia's mean one. It is not inconceivable that not only arthropathies caused by prior enteric and urogenital infection are taken as ReA, leading to the hyperdiagnosis of ReA. The incidence of osteoporosis varies in FDs: from 226.5 per 100,000 adult population in the Siberian FD to52.0 inthe Southern FD, which is most likely to be associated with the fact that an instrumental examination cannot be made in patients to detect this pathology. DOI: http://dx.doi.org/10.14412/1995-4484-2015-120-124

The All-Russian public organization «The Association of Rheumatologists of Russia» (ARR) is in the forefront of the history and present-day activity of Russian rheumatology. In 1928, the Committee on Rheumatism and Control was set up, which was essentially the predecessor to All-USSR (1964) and All-Russian (1987) research societies of rheumatologists, which were succeeded by ARR (1991). Today ARR is one of the largest and influential public health organizations in Russia, the activity of which has been able to sustain and strengthen a rheumatology service in the country and to train a highly experienced professional community rendering care for patients with rheumatic diseases. Innovative biological agents that could substantially improve treatment results have been recently designed. However, cardinal prognosis improvement is associated not only with the introduction of the innovative medicines, but also with the improvement of early-iagnosis-based pharmacotherapy strategy that determines the possible initiation of very early (a window of opportunity) active tightly controlled anti-inflammatory therapy whose goal is to maximally achieve active remission (to treat to target). ARR jointly with European rheumatologists has been engaged in this international initiative shortly since its creation in 2010. Further training of rheumatologists has been one of the main tasks of ARR at all times. ARR has proposed a learningthrough-life model of continuing medical education, by involving rheumatologists at full-term and on-line advanced training cycles, seminars, schools, conferences, meetings, and congresses. At the website of the V.A. Nasonova Research Institute of Rheumatology there is a portal of education programs in rheumatology, which is available to all rheumatologists of the country. Today ARR unites not only rheumatologists, but also physicians of related professions: cardiologists, gastroenterologists, aftercare specialists, traumatologists/orthopedists, endocrinologists, neurologists, and psychiatrists. In the past decade, the All-Russian society of disabled people «Nadezhda (Hope) Association» has joined ARR in implementing its measures.

Objective: to compare the clinical manifestations of coxitis with the data of HJ ultrasound study (USS) on inpatient samples. Subjects and methods . This cross-sectional study enrolled 220 AS patients meeting the modified 1984 New York criteria who had been consecutively admitted to the clinic of the V.A. Nasonova Research Institute of Rheumatology in 2012–2013. A specially designed schedule was filled out for each patient. Disease activity was measured by the BASDAI and ASDAS and functional status was assessed by the BASFI. Coxitis was diagnosed on the basis of clinical signs, such as HJ pain and/or movement limitations on patient admission to the clinic. All the patients underwent HJ USS. Results. The clinical signs of coxitis were found in 162 (73.6%) patients. In 107 (66%) of them, pain intensity recorded by the digital rating scale if only in one joint was 4 scores or higher. The patients with and without the clinical signs of coxitis were matched for age and disease duration. However, in coxitis, high disease activity was detected significantly more frequently and BASFI scores were also significantly higher. USS indicated that 119 (54%) patients had joint effusion. HJ effusion was found in 104 (63%) of the 162 patients with clinically manifest coxitis; and among the 119 patients with USS verified coxitis, 87% were seen to have clinical signs of joint injury and 104 (47%) patients had both clinical and ultrasound signs of HJ injury simultaneously. USS revealed no signs of synovitis in 58 patients with the clinical signs of HJ lesion. Conclusion . Among the patients with AS, the rate of coxitis runs to 51%. The patients with coxitis have higher disease activity and more pronounced functional impairments than those without HJ injury. Coxitis causes considerably diminished working ability. In a number of cases, USS allows, when the clinical manifestations are similar, a differential diagnosis between synovitis and enthesitis located in this area. It is necessary to conduct additional studies to specify the upper limit of the normal range for the neck-capsular distance that is to be kept in mind when diagnosing coxitis by USS.

The paper analyzes the incidence of acute rheumatic fever (ARF) and chronic rheumatic heart disease (CRHD) and theirs outcomes in the Tula Region in 1991 to 2011. In this period, the incidence of ARF decreased to 0.002, which was much lower than Russia's rates. That of CRHD in 2011 accounted for 1.6 per 1,000 adult population, which was comparable to the values in Russia. CRHD mortality rates showed a 2.5-fold decrease. The main causes of fatal outcomes were cardiovascular disorders.

Results of treatment of 76 pts with knee osteoarthritis with native drug Adgelon (glycoprotein possessing biological activity at super low doses) are presented. WOMAC index, Lequesne functional index and SF-36 questionnaire show analgesic effect and quality of life improvement after 6 intra-articular adgelon injections during 3 weeks. Subsequent follow up for 2 months revealed aftereffect of the drug.

В наступившем XXI веке инфекционные заболевания остаются актуальной социальной и медицинской проблемой. Инфекция является одной из ведущих причин смерти в странах с различным уровнем экономического развития. Несмотря на имеющиеся в распоряжении врачей лекарственные средства для этиотропного лечения инфекционных заболеваний, вопросы рациональной антимикробной терапии в различных областях клинической медицины по-прежнему требуют к себе пристального внимания.Вышеизложенное практически полностью относится к ревматологии. Наличие аутоиммунного ревматического заболевания (РЗ) и необходимость применения препаратов с иммуносупрессивным действием нередко обусловливают развитие коморбидных инфекций (КИ) разнообразной локализации, что существенно затрудняет курацию пациентов.

Objective. To study association between bone mineral density (BMD) and clinical and laboratory indices of rheumatoid arthritis (RA) activity Material and methods. 60 women with RA who had not received glucocorticoid and anti-osteoporotic therapy were included. 30 had unchanged menstrual cycle and 30 were postmenopausal. Lumbar spine BMD and proximal femur was studied with double radiological absorptiometry (QDR 1000 Hologic apparatus). W.Wilke indices were used to characterize activity and severity of RA. CRP level was evaluated with quantitative immunoenzyme method. Results. Significant negative association was revealed between spine and femoral neck BMD and RA severity so as between femoral neck BMD and CRP level in pts with unchanged menstrual cycle and in postmenopausal pts.

Arava (leflunomide) was administered to a pt of 39 years of age with definite according to ACR criteria diagnosis of SLE after insufficiently effective treatment with glucocorticoids (intravenous dexam- ethason in total dose of 120 mg and methypred orally 20 mg/day). She received leflunomide (arava) 100 mg/day during the first 3 days and than 20 mg/day. Changes of clinical (arthritis, arthralgia, capillari- tis, fever) and laboratory (ESR.CRP, ANA, anti-DNA, ACL, seromucoid) indices showed good efficacy and tolerability of the drug in this SLE pt.

Arthrosonography of 74 knee joints performed in 37 pts with rheumatoid arthritis before treatment with xefocam (Nicomed) in 34 revealed signs of intra and extra-articular inflammation with presence in 100% fluid in fore part of the joint, increase B. Suprapatellaris size and thickening of synovial membrane. Fluid in lateral parts was revealed in 33 joints and in back part - in 22 joints. Semimembranosus muscle tenosynovitis was revealed at 22 joints. After xefocam administration (intra-articular injections 8 mg once a week for 3 weeks) signs of intra-articular inflammation decreased in 28 and extra-articular - in 21 joints. So xefocam provides anti-inflammatory effect and can be used for treatment of synovitis.

Objective. To investigate sodium fluoride (Ossin, "Grunental") influence on bone mineral density and metabolism in pts with rheumatoid arthritis (RA). Material and methods. An 6-month open controlled investigation was carried out. 30 women were included in 2 groups: premenopausal (aged 20-40 years) (PRM) and postmenopausal (aged 50-65 years) (PSM). 2 control groups were formed according to similar pairs method. Each contained 15 women of corresponding activity, disease duration and age. Pts received sodium fluoride 80 mg/day and Calcium Sandos 500 mg/day. Densitometry (QDR 1000 Hologic) and bone metabolism biochemical markers examination were performed at the beginning and at the end of the study. Bone phosphatase (BP) C- terminal propeptid of type I collagen (PICP), osteocalcin in serum, deoxypiridinolin and piridinolin in urine were measured with immunoenzyme assay ("METRA Biosystems”). Results. BP level increased during follow up in both PSM and PRM groups (from 22,9±I4,0 to 37,7+16,0, p

Interferon system in patients with rheumatoid arthritis infected with hepatitis В and С viruses. R.M. Balabanova, E. V. Vratskih, T.P. Ospelnikova, V.l. Kiseleva Objective. To assess interferon (IFN) status state in pts with rheumatoid arthritis (RA) associated with hepatitis В and С viruses and cryoglobulinemia (CGM). Material and methods. IFN status was assessed in 74 pts with definite RA divided in 4 groups: infected with viruses of hepatitis С (HCV) and В (HBV) (respectively group 1 and 2), RA with CGM (group 3), RA without hepatitis В, С and CGM. IFN status indices were assessed with micromethod in hole heparinized blood. Results. Hepatitis viruses carriers (groups 1 and 2) had significantly elevated circulating IFN level and deep immunocytes IFN producing ability down regulation. In HBV+ RA pts and IFN production decrease was maximal (degree III), in HCV+ RA pts - weaker (degree II). Conclusion. IFN status examination in pts with RA associated with hepatitis viruses and CGM has not only theoretical but also practical importance. Actuality of further study of this problem is determined by necessity of appropriate treatment selection considering IFN system pathology.

Objective. To assess efficacy and safety diclofenacol 1% liniment application in comparison with diclo- ran plus. Material and methods. An open controlled 2-weeks trial of diclofenacol 1% liniment on 30 pts with active joint syndrome (group 1) compared with dicloran plus 1% gel on 20 pts (group II). Pts age ranged from 16 to 79 years, mean disease duration was 8,2 1,5 years. Most pts had II activity degree. Results. Diclofenacol 1% liniment applications decreased pain at rest and at movement and circle of aim joints. In pts with RA effect was more prominent. Dicloran plus provided equivalent results. Local effect of diclofenacol appeared in average after 31,5 min. (from 10 to 73 min) and lasted during 118,3 min (from 50 to 240 min.). Diclofenacol allowed to decrease dose of oral NSAIDs in 43,3% of pts and dicloran - in 40% of pts. Diclofenacol safety was good without local and systemic adverse events. Conclusion. Diclofenacol 1% liniment manufactured by Hiperion S.A. (Rumania) can be recommended for wide administration in treatment of joint diseases particularly in pts with concomitant gastrointestinal diseases and hypertension.

Objective. To define the most important manifestations of early RA. Methods. 92 pts aged 17 to 45 years (mean 34,9 ±8,52 years) with RA of 2-3 activity degree diagnosed during the first months of the disease (mean 3,5 months), were investigated and followed up for one year. Inclusion criteria was the absence of serious concomitant disease of internal organs. Results. During the follow up diagnosis of RA was confirmed in 90 patients (97,8%). SLE was diagnosed in 2 ptss. During the first months of the disease the most considerable manifestations were: morning stiffness, elevation of CRP (3+ and more) - 59 pts (65,5%) and ESR (more than 40 mm/h) - 21 ptss (23,3%), RF more than 1/160 - 46 pts (51,1%). Generalization of joint syndrome (more than 3 joints involved) had all pts at the sixth month of the disease. The onset of the disease with monoarthritis was revealed in 9 of pts (10%), oligoarthritis in 15 (16,7%), polyarthritis in 66 (73,3%). Conclusion. The most important manifestations of early RA are morning stiffness, RF (+), increase of CRP, symmetrical polyarthritis of hands and feet.

Efficacy and tolerability of soluble nimesulid (nimesil) 200 mg/day was assessed in 30 patients with rheumatoid arthritis during an 8-weeks controlled study. Nimesil showed significant analgetic and antiinflammatory effects confirmed by decrease of pain, swollen and painful joint count. Effect was considered as good in 77% of cases. The drug was withdrawn in 3 patients because of side effects (gastrointestinal in 2 and face oedema in I)

Ummary Objective. To reveal J'reguency of accompaning virus infection and possibility to use antivirus therapy together in therapy RA. Material. 40 patients with RA at the age of 17-45 were studied. The duration of disease was not more than 6 months; patients had 2-3 degrees of activity. Every one had a positive rheumatoid factor. Results. 78,2% of the examined patients connected the beginning of the illness with virus infection they have had. The most difficalt variant of RA course and uneffectiveness of basic therapy were registerd among the patients with combination HSV and CMV infection. Inclusion of Cymevene in complex therapy RA has exerted positive influence on clinical-laboratory, signs stregthened effect of basic therapy. Conclusion. The most difficult variant of RA course was registered among the patients with virus infection. Inclusion of antivirus drugs had a positive influence on effectiveness of basic therapy.