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Rheumatoid arthritis (RA) is an immunoinflammatory rheumatic disease (IMRI) characterized by chronic erosive arthritis and systemic damage to internal organs, leading to early disability and reduced life expectancy in patients. Thanks to the progress in the study of the mechanisms of the development of the IVRI and industrial biotechnology, new anti-inflammatory drugs have been created, the use of which has significantly increased the effectiveness of the pharmacotherapy of RA. However, the possibilities of pharmacotherapy for RA are limited, since all genetically engineered biological drugs (GEBDs), regardless of the mechanism of action, have approximately the same effectiveness in achieving remission. It is believed that the relatively unsatisfactory results of RA therapy are due to the heterogeneity of the mechanisms of inflammation. and pain. The significance of the Th17 type of immune response in the pathogenesis of RA, the results of controlled studies of IL-17 inhibitors, and the advisability of further studying the effectiveness of these drugs in patients with certain RA phenotypes are discussed.

Objective – to compare the clinical efficacy and cost-effectiveness of IL-17 inhibitors (SEC, IXE, NTK) in the treatment of adult patients with ankylosing spondylitis (AS) in the healthcare system of the Russian Federation.Material and methods. The study is a sub-analysis of a previously published systematic review and network meta-analysis of the comparative efficacy of biologics in adult patients with AS in the Russian Federation. NNT values were calculated for BASDAI 50 and ASAS 20/40 after 16 weeks of therapy for all studied drugs. CpR was estimated for each biologic after 16 weeks and one year of therapy. Additionally, we carried out an assessment of the financial burden of the most cost-effective strategies for the treatment of AS.Results. The use of NTK is characterized by an average of no more than three patients needed to treat to achieve one ASAS 20/40 or BASDAI 50 response, while on IXE and SEC – no more than 4–5 patients need to be treated, depending on the estimated effectiveness criterion. According to CpR estimate, NTK is the most cost-effective IL-17 inhibitor for the treatment of AS, both after 16 weeks and after one year of therapy.Conclusion. The obtained results make it possible to compare the effectiveness of IL-17 inhibitors from a clinical and economic points of view and can be used both in decision making process of treatment strategies for individual patients, and at the population level – when deciding on the reimbursement of drugs

In population of Russian patients with ankylosing spondylitis (AS), the frequency of clinical manifestations (pain and limitation of functions) of coxitis reaches 56%. Total hip arthroplasty (THA) can be considered as the only alternative that can relieve the suffering of the patient. Radiography and magnetic resonance imaging are widely used methods for assessing structural damage to the hip joint in AS. However, at the moment these methods can’t allow us to fully describe the lifetime changes of these joints. The aim of the study: to analyze the external changes of the femoral heads (HF) and acetabulums during the THA in patients with AS. Materials and methods. The retrospective study included 170 patients with a reliable diagnosis of AS, who met the modified New York criteria of 1984, who were treated in the traumatological and orthopedic department of the V.A. Nasonova Research Institute of Rheumatology in the period from 1998 to 2020, all patients underwent THA as planned. Most of them were male (80.6%). The average age of patients was 38.1±11.3 years and the average duration of the disease since the onset of the first symptoms was 17.0±8.5 years. The duration of pain in hip joints before performing THA is 7.4±4.8 years. The assessment of macroscopic changes in the FH and acetabulum was performed intraoperatively. Results and discussion. Acetabulum protrusion was detected in 108 (63.5%) patients, bone cysts – in 65 (38.2%). Filling of acetabulum with granulation tissue was recorded in 155 (91.2%) patients, presence of osteophytes on its edges – in 153 (90%). Cartilage in the acetabulum was completely absent in 122 (71.8%) patients. FH deformation was detected in 98.2% of cases, erosion in 46.4%. Cartilage on FH was completely absent in 130 (76.5%) patients. In 119 (70%) patients, macroscopic signs of osteonecrosis of FH were found. 79 (46.4%) patients had ankylosis of the hip joint, including fibrous ankylosis – in 77.2% of patients and bone ankylosis – in 22.8%. Conclusion. In patients with AS, the necessity for THA occurs on average after 7.4±4.8 years from the moment of the appearance of first clinical signs of coxitis. In 70% of cases, the macroscopic picture of hip joint lesion was characterized by the development of Avascular necrosis of the femur head (AVNFH), in most patients there was no cartilage in the most loaded segments of acetabulum and FH, in almost half of cases – ankylosis of hip joint and mainly fibrous (77.2%).

Objective – to describe the course of COVID-19 and its effect on ankylosing spondylitis (AS) activity in women infected with SARS-CoV-2 during pregnancy and within one 1 year after childbirth.Material and methods. 78 pregnant women with confirmed AS (modified New York criteria, 1984) were included for prospective observation. In the course of the COVID-19 pandemic (03.2020 – 04.2022) 26 of them were followed during pregnancy and 22 within maximum 12 months after childbirth. The average age of pregnant patients was 33.0±3.9 years, the duration of the disease was 117.0±72.0 months. The average age of patients after delivery was 31.5±4.3 years. The activity according to the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in the 1st, 2nd and 3rd trimester of pregnancy was 2.0±1.4, 2.0±1.4 and 1.9±1.5. The activity according to BASDAI at 1, 6 and 12 months after delivery was 2.0±1.3, 2.2±1.3 and 2.5±2.0 respectively.Results. 4 women were COVID-positive: 3 of them at the beginning of 3rd trimester, 1 – on the 38th week of pregnancy. In 3 cases, the activity of AS was low, in one – high due to axial manifestations and arthritis. In 3 women, the course of COVID-19 was mild, in one – moderate (febrile temperature for more than 3 days); only 1 woman had a dry cough. One pregnant woman canceled AS therapy (certolizumab pegol (CZP)), against which the back pain of the inflammatory rhythm increased. In other cases, AS therapy was not canceled, there was no effect of COVID on AS activity.Within one year after delivery 5 women were COVID-positive. At the time of infection, AS activity in all patients was low, 3 women received CZP. In all cases, COVID proceeded with febrile fever for at least 1 day, while general symptoms disappeared within a maximum of 7 days. Only 1 woman had a dry cough. No effect of COVID on AS activity was found, including in 2 patients who canceled CZP. None of the patients were vaccinated against COVID.Conclusion. According to preliminary data, COVID in pregnant women with AS is to be characterized by a mild to moderate course. During pregnancy, against the background of ongoing therapy, there was no increase in AS activity. During lactation, there was also no effect of COVID on the initially low AS activity. One of the main symptoms of COVID during lactation was a febrile fever, regardless of the period between the childbirth and infection.

Aims of the trial – to study the frequency of drug use in pregnant women with ankylosing spondylitis (AS), to determine the effect of discontinuation of drugs of various groups, as well as the dose of non-steroidal anti-inflammatory drugs (NSAIDs) used, on AS activity during gestation.Material and methods. 50 pregnancies in 49 patients with AS that met the modified New York criteria of 1984. The average age of the patients was 31.7±4.9 years, the duration of the disease was 134.4±85.8 months. The visits were conducted at 10–11, 20–21 and 31–32 weeks of gestation. The BASDAI in the month of conception and in the I, II and III trimesters of pregnancy was: 1.4 [0.6; 3.3], 2.3 [1.2; 4.4], 2.8 [1.4; 4.2] and 2.2 [1.6; 4.0], respectively. The total dose of NSAIDs was determined by the NSAID intake index (Dougados M., 2011).Results and discussion. NSAIDs. After inclusion in the study, the drug of choice was ibuprofen, which was canceled for all women not later than on 32 week of gestation. At the time of conception and in the first, second and third trim. NSAIDs were taken by 23 (46%), 20 (40%), 30 (60%) and 21 (43.8%) women, respectively. NSAIDs intake index in I trimester (5.8 [2.9; 11.8]) was lower than before pregnancy (28.6 [16.7; 50]) and in II (15.5 [4.7; 30.9]) and III trimesters (24.4 [9.5; 50]) (pSulfasalazine (SS) in correspondence with arthritis was taken 3 months before conception by 11 (22%) women, during pregnancy – by 6 (12%) women at a dose of 1.25±0.25 g. Withdrawal of SS was not associated with recurrence of arthritis. Glucocorticoids (GC) at a dose of 7.5±2.5 mg 3 months before pregnancy and in the I, II and III trimesters of pregnancy were taken by 1 (2%), 4 (8%), 8 (16%) and 10 (20.8%) women, of whom 1 patient had arthritis and 1 had inflammatory bowel disease. The rest of the patients received GC due to high AS activity due to axial manifestations and the unavailability of TNFα inhibitors. Against the background of taking GC, the AS activity did not decrease: BASDAI in the II and III trimesters was 5.5±0.6 and 5.8±1.3 (p>0.05). TNFα inhibitors: 3 months before pregnancy and in the trim. of pregnancy were taken by 11 (22%), 7 (14%), 6 (12%) and 2 (4.2%) patients. In those who canceled therapy (both independently and on the recommendation of a rheumatologist) on the eve of pregnancy, an increase in AS activity was noted; BASDAI in the month of conception and in I, II, III trimesters was: 2.7 [0.8; 3.5], 5.1 [3.1; 5.9], 5.5 [5; 6] and 6.7 [5.3; 7.3] (p4) in the II trimester (OR=30.4; 95% CI: 1.5–612.3; p=0.03) and in the III trimester (OR=32.7; 95% CI: 1.6–662.2; p=0.02).Conclusion. NSAIDs and GC in low doses do not reduce the activity of AS. Withdrawal of TNF-α inhibitors on the eve of pregnancy is a predictor of high AS activity. It is necessary to increase the knowledge of rheumatologists and patients about the therapeutic possibilities during pregnancy to avoid unjustified drug withdrawal.

Objective: Assessment of ankylosing spondylitis activity patterns during pregnancy using BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDAS-CRP (Ankylosing Spondylitis Disease Activity Score — C-Reactive Protein) disease activity indices.Materials and methods. The prospective study included 36 pregnant women with AS (modified New York AS criteria, 1984). Patients’ mean age was 31.6±4.8 years, mean age at AS onset was 21.8±10.9, and disease duration 134.9±89.3 months. The control group included 30 healthy pregnant women with no history of back pain and arthritis, their mean age was 28.2±4.5 years. In the I trimester of pregnancy 10 (33.3%) As patients experienced back pain, while in the III trimester already 15 (50%) had back pain. Throughout pregnancy, the intensity of back pain in the I, II и III trimesters based on numeric scale was on average 1.9±0.9; 2.1±1.1 and 2.1±0.8. BASDAI and ASDAS-CRP were used to measure disease activity on gestational Weeks 10–11, 20–21 and 31–32. The time of conception BASDAI score was assessed retrospectively at the 1st visit.Results and discussion. BASDAI mean values at the time of conception and I, II и III trimesters of pregnancy were: 2.3±1.9; 2.8±1.72 (ppp=0.01). Throughout pregnancy, the intensity of back pain in AS patients and healthy pregnant women with back pain did not differ (prs ≥0,7) correlation of all BASDAI components with the index itself in each trimester of pregnancy, except for joint pain in the month of conception, and in the I and III trimesters was established in the group of pregnant women with AS. The control group had quite high correlation (rs >0.7) of fatigue severity with the BASDAI index in the I and II trimesters of pregnancy and moderate correlation (rs >0.53) in the III trimester; as wells as moderate (rs >0.5-0.69) correlation between back pain and BASDAIConclusion. A trend towards increasing AS activity based on BASDAI and ASDAS-CRP scores and CRP levels was established for the first half of pregnancy. Later in pregnancy these increased values failed to return to normal until the end of gestation. The percentage of AS patients with highto-moderate disease activity throughout pregnancy was lower based on BASDAI score vs based on ASDAS-CRP. Some BASDAI components (fatigue and back pain) reflect not only the activity of AS, but also changes associated with physiological pregnancy. The BASDAI index requires adaptation for use in pregnancy

Objective: To evaluate maternal and neonatal pregnancy outcomes in ankylosing spondylitis (AS) patients.Subjects and methods. The prospective study included 36 pregnant women with AS (modified New York AS criteria, 1984), all participants were followed. Mean patients’ age was 31.6±4.8 years, age at disease onset – 21.8±10.9 years, duration of the disease – 134,9±89.3 months. Stage II-III sacroiliitis was diagnosed in 88.9% of women, stage IV – in 11.1%. AS activity levels measured by mean BASDAI score in I, II and III trimesters were 2,8±1,7 – 3,2±1,9 – 3,3±2,1, respectively.Results. 34 pregnancies resulted in live births at median 39 [38; 40] weeks of gestation. Adverse pregnancy outcomes were documented in 2 cases (5.6%): a missed miscarriage at 18 weeks of gestation in a woman with burdened maternal obstetric history and moderate AS activity; and medical abortion at 23d week of gestation because of fetal critical condition owing to persistent high AS activity with severe axial and extra-articular manifestations of the disease. Most common pregnancy complications included threatened early miscarriage (11.1%), threatened premature labor (11.8%), infectious and inflammatory conditions (pyelonephritis in pregnancy, acute respiratory viral infections – 36,1%), iron-deficiency anemia (19,4%), gestational hypothyroidism (11,1%). Preterm birth was documented in 5,9% patients. No association was found between disease activity, therapy, and preterm birth. There were no cases of preeclampsia. 52.9% of the patients had vaginal delivery, and 47.1% had a caesarean section (CS), which was elective in 87.5% of all CS cases. Indications for elective CS included severe hip joints involvement with altered function, and scar on the uterus. Emergency C-section was performed in cases of uterine inertia and preterm discharge of amniotic fluid. Average birthweight of newborns was 3384.4±382.0 g, and length –51.5±2.0 cm, Apgar score was 8.0±0.4/8.9±0.4. Early neonatal complications were documented in 14,3% newborns, Congenital abnormalities were registered in 3 (8.6%) newborns: a slit-like defect of the atrial septum, a defect of the interventricular septum, and unilateral hydronephrosis.Conclusion. Pregnancy outcomes in AS patients practically do not differ from those in general population, except for higher rates of elective C-sections, being generally favorable given AS activity is adequately controlled and gestation &delivery are thoroughly monitored. AS is not associated with higher rates of severe pregnancy complications and preterm birth. AS seemed to have no negative impact on newborn anthropometric data and health condition in general. No severe neonatal complications occurred. Considering the small sample size, it is impossible to draw definite conclusions about occurrence of various malformations in newborn to mothers with AS at this particular stage of the research. Interdisciplinary consensus is necessary in place to optimize pregnancy and birth management in AS patients

In addition to damage to the spine and joints in ankylosing spondylitis (AS), as in other diseases from a group of spondyloarthritides (SpA), there can be the following extra-articular manifestations: inflammatory bowel disease (IBD), uveitis, psoriasis, and kidney and heart diseases. In the last decade, much attention has been paid to the association between SpA and IBD; the common pathogenetic mechanisms of these diseases have been identified. The relationship between inflammation and blood coagulation has been known since ancient times, and its evidence base is constantly expanding. Both of these processes are accompanied by platelet activation and fibrin formation. The authors present a clinical case of a female patient with the comorbidity of AS with IBD and iliocaval thrombosis.

The paper presents the results of a double-blind (BCD-085-3/AILAS) phase II clinical trial of the original interleukin 17A (IL17A) inhibitor BCD-085 prescribed at different doses to patients with active ankylosing spondylitis (AS) and those of an extended (BCD-085-3ext/AILAS-II) trial characterizing the efficacy and safety of this drug when used for a year. The objective of the AILAS study is to determine the therapeutically effective and safe dose of BCD-085 in the treatment of active AS. The efficacy, safety, and immunogenicity of BCD-085 during its annual use were additionally evaluated in the extended trial. Subjects and methods . The investigation enrolled 89 patients diagnosed as having active (BASDAI scores >4.0; mean spinal pain scores >4.0) AS that met the 1984 New York classification criteria. After the end of the screening period, the patients were randomized at a ratio of 1:1:1:1 in one of four groups that received 40; 80 or 120 mg of BCD-085 subcutaneously or placebo on day 1 of weeks 0, 1, 2 and then once every two weeks up to week 12. The primary end point was the number of patients who achieved an ASAS20 response at week 16. The investigation evaluated the safety of the drug, by calculating the total incidence of adverse events (AEs) and serious AEs (SAEs) and the number of cases of premature therapy termination because of AEs. Results and discussion . An ASAS20 response at week 16 was achieved in 72.7% of patients receiving 40 mg of BCD-085, in 81.8% of those receiving 80 mg, in 90.9% of those receiving 120 mg, and in 42.9% of cases in the placebo group (p=0.004). The superiority of BCD-085 over placebo was proven for 80- and 120-mg doses. The fastest and most pronounced effect was observed in patients treated with 120 mg of BCD-085. In the extended study, an ASAS20 response at week 52 was recorded in 86.4% of patients. One or more AEs during the first 16 weeks of therapy were reported in 11 (50.0%) patients of the 40-mg group; in 6 (27.3%) of the 80 mg group; in 4 (18.2%) of the 120 mg group and in 7 (31.8%) of the placebo group (p=0.183). The frequency and spectrum of AEs did not significantly differ in patients who received placebo and BCD-085 in different doses. No SAE was recorded. Conclusion. Phase II study yielded data demonstrating the high efficacy and good tolerance of BCD-085 in the treatment of active AS. The best effect and optimal tolerance were demonstrated for a dose of 120 mg.

Objective : to present cases of Behcet's disease (BD) concurrent with axial spondyloarthritis (axSpA). Subjects and methods . A total of 470 patients with BD who met the International Standard Bibliographic Description (ISBD) criteria were examined at the V.A. Nasonova Research Institute of Rheumatology in the period from 1990 to 2018. In 9 of them, BD was concurrent with axSpA; 7 out of the 9 patients met the 1984 modified New York criteria for ankylosing spondylitis (AS) and two patients fulfilled the 2009 ASAS non-radiographic axSpA criteria. Results and discussion . Most (55.6%) patients were men. BD was preceded by axSpA in 6 patients. The symptoms of AS joined an average of 8.4 [2; 10] years after the onset of the clinical manifestations of BD. Three patients developed BB 9–15 years after the onset of the first symptoms of axSpA. The mean duration of BD was 14.0±7.8 years and that of axSpA was 10.9±6.2 years. All the patients were HLA-B27-positive; three were found to have B5 antigen. All the 9 patients had mucocutaneous manifestations that were characteristic of BD. Four patients were diagnosed as having eye injuries: generalized uveitis with retinal vasculitis, posterior uveitis with or without retinal vasculitis. Gastrointestinal tract lesions were detected in 44.4% of cases. Peripheral arthritis was present in all the patients. Entheseal involvement was observed in 66.7% of patients. The radiographic signs of bilateral sacroiliitis according to the modified New York criteria were found in 7 (77.8%) patients; MRI revealed active inflammatory changes in the area of the sacroiliac joint in 3 (33.3%) patients. Conclusion . The fact that there may be an overlap between BD and axSpA should be taken into account in everyday clinical practice, which will assist in choosing the optimal treatment strategy.

Currently, there have been a small number of works on differences between males and females with axial spondyloarthritis (axSpA) and there have been no studies estimating a gender difference in radiographic sacroiliitis progression in axSpA.Objective: to compare the main clinical manifestations of sacroiliitis and its radiological progression in axSpA in men and women over time during a 2-year follow-up period.Subjects and methods. The investigation was conducted using the Moscow cohort from the early SpondyloArthritis (CoRSAr) study, which currently consisted of 175 patients. The analysis included 68 patients followed up for ≥2 years. Their mean age at the time of inclusion in the cohort was 28.5±5.8 years; the mean disease duration was 24.1±15.4 months. 92.6% of patients were HLA-B27-positive.Results and discussion. Among the 68 patients followed up over 2 years, there were 33 (48.5%) men and 35 (51.5%) women. At baseline, the females were older than the males (pConclusion. Women fall ill with axSpA later than men, and the latter are more frequently observed to have HLA-B27, higher tsrSI and elevated CRP levels. Progression from non-radiological axSpa to AS was more common in men.

Objective: to evaluate the effect of golimumab (GLM) on the clinical, functional, and instrumental manifestations of coxitis in ankylosing spondylitis (AS).Subjects and methods. The non-interventional prospective multicenter cohort study GO-COX conducted in the medical centers of the Russian Federation enrolled 39 patients with AS (meeting the modified New York criteria) and coxitis with BASRI-hip score 0–2, who were prescribed GLM as the first biologic agent at a dose of 50 mg per month. The patient's health status was assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP), and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) before and at 6 and 12 months after GLM treatment initiation. Based on the data of radiographs (the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-hip) scoring system), ultrasonography (USG), and STIR and T1 magnetic resonance imaging (MRI), the investigators assessed the manifestations of coxitis. The planned follow-up duration was 2 years. This paper includes 12-month follow-up results in 22 patients.Results and discussion. At 12 weeks of GLM therapy, there were significant positive index changes: a decrease in BASDAI by an average of 3.28±1.62, in ASDAS-CRP by 2.20±0.95, in BASFI by 2.52±2.09, and in BASMI by 1.41±1.50 (pConclusion. At 12 weeks, GLM therapy in patients with AS and coxitis provided a reduction in the clinical and instrumental signs of coxitis, as evidenced by MRI and USG (a significant decline in the proportion of patients with subchondral bone edema and intraarticular effusion), and also effectively suppressed other manifestations of inflammatory activity.

Objective: to compare the impact of continuous or on-demand use of nonsteroidal anti-inflammatory drugs (NSAIDs) on the activity and radiographic progression of early axial spondyloarthritis (axSpA).Subjects and methods. The investigation enrolled patients from the early spondyloarthritis cohort who met the 2009 Assessment of Spondyloarthritis International Society (ASAS) criteria for axSpA. This analysis included 68 patients who had been followed up for at least 24 months. The mean age at the time of inclusion in the investigation was 28.5±5.8 years; the mean disease duration was 24.1±15.4 months; 63 (92.6%) patients were HLA-B27-positive. The patients were divided into two groups: 1) 35 patients used NSAIDs at maximum therapeutic doses continuously during the follow-up period; 2) 33 patients received these drugs on-demand, depending on the presence and severity of back pain.Results and discussion. After 2-year follow-up, the median stage of radiographic sacroiliitis (SI) in Group 1 was unchanged and remained equal to 4; that in Group 2 in this period significantly increased from 3 to 4 scores (p < 0.05). At baseline, the patient groups did not differ in C-reactive protein (CRP) levels, the Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), and the Bath Ankylosing Spondylitis Functional Index (BASFI); however, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was higher in Group 1 (p < 0.05). The number of patients with active SI, as evidenced by magnetic resonance imaging (MRI), and the degree of its severity did not differ significantly between groups. After 2 years, all the patients retained low disease activity according to ASDAS-CRP, BASDAI, and CRP levels; and these measures did not differ significantly between groups either; the BASFI became higher in Group 1. MRI findings indicated that the number of patients with active SI decreased, but no differences were found between the groups.Conclusion. In patients with early axSpA, the continuous intake of NSAIDs can slow radiographic progression to a greater extent than their on-demand use.

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.

The paper gives the recommendations for the assessment of disease activity and functional status in patients with ankylosing spondylitis in clinical practice, which have been developed by experts, by taking into account international and Russian experience in managing these patients.

Telemedicine, including mobile applications for patients, is progressing rapidly now. However, patients with axial spondyloarthritis (axSpA) still have no applications that can be used to monitor their health status independently and to contact their physician remotely. Objective: to develop and test an «ASpine» mobile application for smartphones in real clinical practice. Material and methods. The draft «ASpine» mobile application has two parts: a mobile application for patient and a personal computer program used by a rheumatologist to monitor disease activity in patients. The patient part of «ASpine» consists in filling out the BASDAI and BASFI questionnaires and monitoring how recommendations for daily exercise therapy and medications are fulfilled. There is also an opportunity for constant contact with the physician through the mobile application. The patients from the Moscow cohort CoESAr (Cohort of Early SpondyloArthritis) which was made up at the V.A. Nasonova Research Institute of Rheumatology in 2013 and is being formed to the present time took part in mobile application testing. Results and discussion. The mean scores of BASDAI at inclusion and after 12-month follow-up were 3.3±1.7 and 2.1±1.7 (p > 0.5) and those of BASFI were 1.6±1.3 and 1.3±1.2, respectively (p > 0.5). To analyze the health status of 35 patients, one doctor requires 1 min daily if there are no reports of their worse health. It takes an average of 5–8 min to make a decision if the patient reports the occurrence of any symptom or an adverse reaction. The findings can lead to the conclusion that the «ASpine» mobile application allows patients to independently monitor disease activity, to store medical records, and to contact their physician remotely. Continuous monitoring of the patient's condition makes it possible to maintain low disease activity or remission for a long time.

The rate of osteoporosis (OP) and the mechanism of its development in patients with ankylosing spondylitis (AS) and other spondyloarthrititides (SpA) have not been sufficiently investigated. Steady-state inflammatory disease activity is anticipated to be the leading factor of OP in AS. Objective: to investigate lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD) in patients with early axial SpA (axSpA) and to reveal its association with inflammatory disease activity. Subjects and methods. A total of 150 patients (59 men and 91 women) aged 18 to 45 years with inflammatory back pain for ≥3 months and ≤5 years were examined. The diagnosis of axSpA was established in accordance with the 2009 ASAS criteria. BASDAI and ASDAS-CRP were used to assess activity and functional status was evaluated with BASFI. The examination included determination of HLA-B27, X-ray of the pelvis and LS, magnetic resonance imaging (MRI) of the sacroiliac joints, LS, and hip joints (in the presence of clinical signs of their involvement), and densitometry of LS (LI–IV) and FN. By taking into account the patients’ young age, the Z score was used to estimate BMD. The Z-score -2 SD or lower in at the least one of the regions examined is considered to be diminished BMD. Results and discussion. The median Z-score was -0.7 [-1.3; -0.2] SD for FN and -0.9 [-1.6; -0.6] SD for LS. Reduced BMD in at the least one of the regions examined was diagnosed in 27 (18.0%) patients. There was lower BMD in LS in 21 (14.0%) patients and in FN in 8 (5.3%). Two (1.3%) patients were diagnosed as having osteopenia in the two examined regions. There was no association between diminished BMD and age, gender, disease activity assessed with BASDAI, ASDAS-СRP, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). An association was found between inflammatory LS changes, as evidenced by MRI (MRI spondylitis), and reduced BMD in at least one of the examined regions. MRI spondylitis was detected in 27 (18.0%) patients. Decreased BMD in any of the examined skeletal regions was seen in 9 (33.3%) of the 27 patients having MRI spondylitis; the remaining 18 (66.7%) patients had normal BMD values. In the absence of MRI spondylitis, osteopenia was identified in 18 (14.6%) patients; normal BMD values were noted in 105 (85.4%); p = 0.03). There was also a relationship between the presence of MRI spondylitis and diminished BMD in the same region. LS osteopenia was found in 7 (25.9%) patients with MRI spondylitis and LS BMD remained within the normal range in 20 (74.1%). In the absence of MRI spondylitis, LS osteopenia was observed in 14 (11.4%) patients and LS BMD was normal in 109 (88.6%) (p < 0.05). Conclusion. There was an association between inflammatory LS changes, as evidenced by MRI, and reduced BMD in the same region. Our findings confirm the hypothesis that bone mass loss in the vertebral bodies in early axSpA results from local inflammation.

Until recently there is no clarity in the nosological independence of non-radiographic axial spondyloarthritis (nraxSpA). Cohort studies can assist in solving this problem. In 2013, the V.A. Nasonova Research Institute of Rheumatology started to form a Cost and Resource utilization Study in Antiretroviral treated patients (CoRSaR) cohort to investigate the evolution of nr-axSpA and treatment policy for this condition. This communication deals with the preliminary results of a 12-month follow-up study of the CoRSaR cohort. Subjects and methods. The cohort was recruited from all consecutive patients with a < 5-year history of nr-axSpA who sought for medical advice and treatment. The patients were examined in accordance with the Ankylosing Spondylitis Assessments (ASAS) International Working Group guidelines at inclusion and after 12 months. A total of 94 patients with axSpA were enrolled; 54 patients out of them were included into a preliminary analysis of the evolution of axSpA; their mean age at inclusion was 27.1±5.5 years and the mean disease duration was 22.4±15.1 months; 49 (90.7%) patients were HLA-B27 positive. 31 of the 54 patients had ankylosing spondylitis(AS) and 23 had nr-axSpA. Results and discussion. The patients with AS and those with nr-axSpA showed virtually no difference in main clinical parameters, such as the presence of arthritis, enthesitis, BASDAI, ASDAS-CRP, and BASFI. By the end of the 12month follow-up, both groups virtually displayed almost a double reduction in all inflammatory markers but erythrocyte sedimentation rate. Nine (39%) patients with nr-axSpA developed radiographic sacroiliitis over 12 months and the diagnosis of AS was confirmed. Conclusion. 39% patients with nr-axSpA developed radiographic sacroiliitis at the 12-month follow-up. Nr-axSpA should be regarded as an early stage of AS.

Coxitis is one of the characteristic clinical manifestations of ankylosing spondylitis (AS). Hip joint (HJ) damage in AS is regarded as a poor prognostic factor and the early detection of coxitis is of great importance, as timely adequate therapy may reduce the risk of irreversible HJ changes. Coxitis may be diagnosed clinically and using different imaging techniques, each of which can characterize different aspects of damage of these joints. The lecture considers the clinical and instrumental diagnosis of coxitis in AS.

By the end of the first decade of the 21st century, spondyloarthritis studies have accumulated a certain number of terms that are obsolete, but used by physicians in their everyday speech, on the one hand, and a great variety of different definitions, on the other hand. In January 2014, the first organizational meeting of the Expert Group on Spondyloarthritis, Association of Rheumatologists of Russia, decided that its primary task should be to order the terminology used in this area. The authors primarily collected the terms, which had been already used in medical vocabulary, and then divided them into two categories: obsolete definitions and terms to be finalized and unified. This publication gives guidelines for using the medical terms relevant to spondyloarthritis and separately discusses how to correctly write the term sacroiliitis.

Hip joint injury, coxitis, is a characteristic manifestation of ankylosing spondylitis. Coxitis therapy has not been elaborated so far. There are few publications on the efficacy of tumor necrosis factor-α inhibitors. Alternative pharmacotherapies, including use of methotrexate, have not fully been studied. The study describes clinical cases of coxitis treated in patients with early spondyloarthritis.

Objective: to study clinical manifestations of axial spondyloarthritis (axSpA) fulfilling ASAS criteria and to evaluate Russian version of modified New York criteria for the diagnosis of AS in Russian patients. Subjects and methods . Authors examined 73 patients aged 18–45 years suffering from inflammatory back pain for a period from 3 months to 5 years. BASDAI and ASDAS-CRP were used to assess activity, whereas BASFI – to evaluate functional status. Examination included: assessment of HLA-B27 rate, X-ray of pelvis and lumbar spine, ultrasonography of hip joints and calcaneal regions, magnetic-resonance imaging (MRI) of sacroiliac joints, lumbar spine and hip joints (if clinical signs of injury are present), densitometry of lumbar spine (LII–IV) and femoral neck. Results . Mean age of patients was 28.3±6.4 years, mean duration of disease – 19.9±14.4 months. HLA-B27 was found in 94.5% of patients. Mean BASDAI value was 4.1±1.9; ASDAS – 2.7±1.3; BASFI – 2.6±2.1. Peripheral arthritis was observed in 65.8% of cases, coxitis – in 31.5%, calcaneal enthesitis – in 61.6%, dactylitis – in 19.2%, low bone mineral density – in 17.8%. MRI showed inflammatory changes of axial skeleton in 84.9% of patients, active sacroiliitis (SI) – in 72.6%. X-ray revealed definite SI in 49.3% of patients («classic» AS). According to MRI data, 30.1% of patients with active SI and without structural changes of sacroiliac joints had pre-radiological stage of AS (by Russian version of modified New York criteria). 74.0% of patients fulfilled both sets of ASAS criteria for axSpA, 5.5% – met only I criteria set, whereas 20.5% – only II criteria set. Three groups of patients were defined. The first included patients with radiologically proven SI, the second – with MRI-proven SI and the third – patients without SI. Significant difference between the groups was detected either by gender (number of males in groups I and II exceeded that in group III: p1–3=0.002, p2–=0.033) or by the rate of high activity according to ASDAS index (observed in groups I and II more frequently than in group III; p=0.02 in both cases) or by presence of inflammatory changes in spine in MRI scans (detected in 26% of patients of group III, not detected in patients of group II; p=0.05). Conclusion. Half of patients with axSpA symptoms longer than 20 months already have structural changes in sacroiliac joints, so they can be diagnosed as «classic» AS. 80% of patients who had axSpA for less than 5 years match the description of AS provided by Russian version of modified New York criteria; one third of them has pre-radiological stage of disease. Number of males with radiologically proven SI and MRI-proven SI was larger than that of patients without SI. SI is often accompanied with high activity according to ASDAS. MRI showed that, inflammatory processes in spine may precede active SI. No clinical differences were revealed between patients with radiogically proven AS and pre-radiological stage of AS described by Russian version of modified New York criteria.

Objective. To study how the patients with ankylosing spondylitis (AS) follow recommendations for performing physi- cal exercises. Material and methods. To clarify the compliance of patients with AC to physical exercise, a special questionnaire was designed. The Exercise Benefits/Barriers Scale (EBBS) was used to assess the perception of physical exercises. The study included 79 patients (the mean age of 34.5 ± 9.4 years) with AS (diagnosed according to the New York criteria) who have been treated at the clinic of V.A. Nasonova Research Institute of Rheumatology of the Russian Academy of Medical Sciences. Results. Of the 79 patients included in the study, 77.2% were doing therapeutic exercises; 41.0% of patients were doing them every day. 41.0% of the patients have received sets of exercises from the attending doctor, 41.0 % from the Internet, and 18.0% from other sources (brochures for patients or courses for patients with AS). The average total EEBS score was 114.2 ± 17.8 points; the benefits score was 87.1 ± 12.8; and the barriers score was 27.1 ± 5.0. The most frequent responses to question about the benefits of physical exercises were as follows: «They reduce the feeling of stress and tension» (90.6%) and «They increase the muscle strength» (93.7%). «I am tired physically from doing exercises» (96.6%) was the most common barrier to execution of physical exercises. Conclusion. Despite the positive perception of physical exercises, only 41.0% of the patients with AS have done them every day. The lack of information about exercises recommended for AS patients, the frequency of their use, the effect on the disease activity and functionality significantly limits the use of exercises by patients with AS. It remains unclear exactly, which sets of exercises are most effective and what regularity of exercises should be used to prevent impair- ment of the functions of the spine and joints.