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The emergence of modern methods of treatment of systemic lupus erythematosus (SLE) has led to an increase in the duration and quality of life of patients with this disease. However, the majority of patients with SLE are women, and it is well known that the female sex hormone estrogen can influence the activity of systemic autoimmune diseases, including SLE. An increase in life expectancy means an increase in the length of a postmenopausal woman’s stay, with the possibility of the appearance of classic menopausal disorders, and the development or aggravation of comorbid pathologies, primarily osteoporosis and cardiovascular diseases, as well as the need to improve the quality of life for women with these diseases. This review collects and analyzes data on the risks and benefits of using menopausal hormone therapy for SLE.

Objective: to study the safety and efficacy of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) in patients with systemic lupus erythematosus (SLE).Patients and methods. The study included 75 patients with definite diagnosis of SLE at the age of 19–68 years, 10 (13%) of them had high SLE activity, 18 (24%) – moderate, 42 (56%) – low, in 5 (7%) patients the disease was in remission. PPV-23 was injected subcutaneously in a single dose of 0.5 ml. In 60 patients the follow-up period was ≥12 months, in 15 – from 2 to 6 months. Patients were examined before and 1, 3 and 12 months after immunization.Results and discussion. In 38 (50.7%) patients, standard local vaccination reactions of mild and moderate severity were noted, in 1 (1.3%) – a general reaction of mild severity, in 2 (2.7%) – mild diarrhea during 1 day, in 1 (1.3%) – a hyperergic reaction of the Artyus phenomenon type, the symptoms were relieved within 7 days. During 12 months of follow-up, neither exacerbations of SLE, reliably associated with vaccination, nor new autoimmune phenomena, were detected. After 1 year of observation, the number of responders to vaccination was 58%, non-responders – 42%. The duration and activity of the disease, age over 50 years, glucocorticoid therapy > 10 mg per day, did not significantly affect the vaccine response. There was a decrease in the immune response in patients on biologic DMARDs (bDMARDs) therapy compared to patients without such treatment (43 and 68% of cases, respectively), p=0.058. There was no difference between rituximab and belimumab treated subjects. There was a tendency for the prevalence of vaccination responses among patients, who received bDMARDs Conclusion. Sufficient immunogenicity, good tolerability and clinical efficacy of PPV-23 in patients with SLE, including those who received combined immunosuppressive therapy, have been shown. The use of bDMARDs reduces the number of patients with a vaccine response. The number of responders to vaccination increases when immunization is carried out before the initiation of therapy with bDMARDs or when this therapy is initiated

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are the most common autoimmune rheumatic diseases (RD) that occur mostly in women of childbearing age, and the occurrence of pregnancy is an expected fact. Due to the ongoing disputes over the ethics of maintaining birth rates among an unhealthy population, modern researchers focus attention on studies of the mutual impact of RD and pregnancy, on the safety of pharmacotherapy during conception and gestation, and on the health of the offspring born to female patients with RD.Objective: to evaluate the neonatal outcomes of pregnancy in patients with RA and SLE.Subjects and methods. An investigation was conducted to study the health status of 73 babies born to 72 female patients with RD (76 cases of pregnancy), of whom 29 patients with RA (32 cases of pregnancy) and 43 with SLE (44 cases of pregnancy) were followed up prospectively at the V.A. Nasonova Research Institute of Rheumatology and the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology. The health status of the babies was evaluated in the first year of their life. Supervising neonatologists and pediatricians recorded abnormalities in the newborns and subsequently analyzed using their medical records (extracts from maternity hospitals, children's hospitals, and outpatient cards).Results and discussion. Of the 76 supervised pregnancies, 72 (94.7%) resulted in 73 live births (one twin pregnancy in a patient with SLE). There were three (6.8%) cases of pregnancy loss in the second trimester in patients with SLE having antiphospholipid syndrome (APS) and one (3.1%) case of perinatal death (a boy and a girl from a monochorionic diamniotic twin with reversed arterial perfusion) in a patient with seropositive RA. The height and body weight of all the newborns conformed to gestational age. Patients with RA and SLE compared to the population more often gave birth to low birthweight babies (9.7 and 21.4% versus 60.9 per 1,000 live births in the Russian population). In the groups of mothers with RA and SLE, their infants had a high Apgar score of 8–9 at one and five minutes. Various abnormalities were detected in 5 (16.1%) and 15 (35.7%) babies born to mothers with RA and to those with SLE, respectively. Among the neonatal congenital anomalies (malformations), there was patent foramen ovale, patent ductus arteriosus, and hip joint dysplasia, which were more common in the babies born to mothers with SLE having APS and exceeded the population-based incidence of these anomalies. The babies were more commonly diagnosed with congenital pneumonia than those in the population; there were single cases of umbilical hernia, hemangioma, thrombocytopenia, hemorrhagic disease of the newborn, perinatal encephalopathy, and congenital hearing loss.Conclusion. The mothers with RA and SLE more often gave birth to low birthweight babies than did those in the population. The infants born to mothers with RA and SLE had significantly more frequently congenital heart defects (patent foramen ovale, patent ductus arteriosus) and congenital pneumonia. The detected abnormalities were more common in the newborns born to mothers with SLE having APS. Maternal RA and SLE activities and/or performed therapy were not found to have a negative impact on the incidence of abnormalities in babies.

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are the most common autoimmune rheumatic diseases (RD) that occur mostly in women of childbearing age, and the occurrence of pregnancy is an expected fact. Due to the ongoing disputes over the ethics of maintaining birth rates among an unhealthy population, modern researchers focus attention on studies of the mutual impact of RD and pregnancy, on the safety of pharmacotherapy during conception and gestation, and on the health of the offspring born to female patients with RD. Objective: to evaluate the neonatal outcomes of pregnancy in patients with RA and SLE. Subjects and methods. An investigation was conducted to study the health status of 73 babies born to 72 female patients with RD (76 cases of pregnancy), of whom 29 patients with RA (32 cases of pregnancy) and 43 with SLE (44 cases of pregnancy) were followed up prospectively at the V.A. Nasonova Research Institute of Rheumatology and the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology. The health status of the babies was evaluated in the first year of their life. Supervising neonatologists and pediatricians recorded abnormalities in the newborns and subsequently analyzed using their medical records (extracts from maternity hospitals, children's hospitals, and outpatient cards). Results and discussion. Of the 76 supervised pregnancies, 72 (94.7%) resulted in 73 live births (one twin pregnancy in a patient with SLE). There were three (6.8%) cases of pregnancy loss in the second trimester in patients with SLE having antiphospholipid syndrome (APS) and one (3.1%) case of perinatal death (a boy and a girl from a monochorionic diamniotic twin with reversed arterial perfusion) in a patient with seropositive RA. The height and body weight of all the newborns conformed to gestational age. Patients with RA and SLE compared to the population more often gave birth to low birthweight babies (9.7 and 21.4% versus 60.9 per 1,000 live births in the Russian population). In the groups of mothers with RA and SLE, their infants had a high Apgar score of 8–9 at one and five minutes. Various abnormalities were detected in 5 (16.1%) and 15 (35.7%) babies born to mothers with RA and to those with SLE, respectively. Among the neonatal congenital anomalies (malformations), there was patent foramen ovale, patent ductus arteriosus, and hip joint dysplasia, which were more common in the babies born to mothers with SLE having APS and exceeded the population-based incidence of these anomalies. The babies were more commonly diagnosed with congenital pneumonia than those in the population; there were single cases of umbilical hernia, hemangioma, thrombocytopenia, hemorrhagic disease of the newborn, perinatal encephalopathy, and congenital hearing loss. Conclusion. The mothers with RA and SLE more often gave birth to low birthweight babies than did those in the population. The infants born to mothers with RA and SLE had significantly more frequently congenital heart defects (patent foramen ovale, patent ductus arteriosus) and congenital pneumonia. The detected abnormalities were more common in the newborns born to mothers with SLE having APS. Maternal RA and SLE activities and/or performed therapy were not found to have a negative impact on the incidence of abnormalities in babies.

The use of factor Xa inhibitors is justified in the therapy of thrombosis in antiphospholipid syndrome (APS) and active lupus nephritis (LN). To monitor the efficacy and safety of these drugs, plasma anti-Xa (aXa) activity is determined. Objective : to assess the aXa activity of selective and non-selective factor Xa inhibitors in patients with systemic lupus erythematosus (SLE) and APS depending on how they affect the kidneys. Patients and methods. Clinical and laboratory findings were prospectively analyzed in SLE and APS patients who long received low molecular weight heparins (LMWHs) and selective Xa inhibitors, such as fondaparinux and rivaroxaban. The investigation enrolled 70 patients (54 females and 16 males) aged 39 years (range, 31 to 43 years) with SLE (n=15 (21%)), primary APS (PAPS) (n=10 (14%)), and SLE + APS (n=45 (65%)). Results . Kidney disease was diagnosed in 33 (47%) of the 70 patients. LN was detected in 15 (25%) of the 60 patients: 10 and 5 patients with SLE and SLE + APS, respectively. APS nephropathy (APSN) was manifested by elevated creatinine and urea levels with normal urine sediment and no history of glomerulonephritis and was observed in 18 (33%) of the 55 patients: in 16 with SLE + APS and 2 with PAPS. The therapeutic aXa range of 0.1—1.5 IU/ml was found in 43 (61%) of the 70 patients, low and high aXa activities were seen in 14 (20%) and 13 (19%) patients, respectively. In patients with APSN, the creatinine clearance (CC) depended on aXa levels: the highest CC was noted in patients with aXa >1.5 IU/mL, the lowest CC was in those with aXa

Objective: to clarify pregnancy outcomes in patients with ankylosing spondylitis (AS) and its course during pregnancy on the basis of a retrospective analysis. Subjects and methods . The paper presents the results of Stage 1 of a Russian pilot study of the impact of pregnancy on AS activity, parity, and pregnancy outcomes in these patients. The basis for Stage 1 is the results of a retrospective analysis of the data of a questionnaire survey of 204 women with AS, during which they answered 19 questions regarding the presence of pregnancies and their outcomes, the reasons for the lack of pregnancies, and a subjective assessment of their health status during gestation. The respondents’ mean age was 32.0±5.8 years; the mean disease duration was 107.2±73.5 months. Results and discussion . 84 (41.1%) women did not have pregnancies; the reasons for the lack of pregnancies were associated with AS (fear of the teratogenic effect of taken drugs; a child’ inheritance of the disease) in 48.8% of the cases, with infertility in 9.5%, and with non-medical reasons in 41.7%. A total of 120 (58.9%) women had 248 pregnancies; of whom 136 patients had the latter before and 112 – after the onset of AC. In AS versus a healthy life period, there were lower abortion rates at a woman’s will (8.9 and 35.3%, respectively; p < 0.01), more pregnancies that resulted in childbirth (75.9 and 52.2%, respectively; p < 0.01), and higher surgical delivery rates (43.5 and 28.2%, respectively; p < 0.05). The premature birth rate after the onset of AC was 13.0%. The newborn infants born before the onset of AS in mothers did not differ from those born after the onset of AS in mothers in weight and Apgar scores. Half of the respondents reported that their health status was improved in any trimester of pregnancy (slightly more often in the first trimester; but the difference was statistically insignificant). However, almost 70.0% of the respondents noted their worse health status during pregnancy, the severity of AS symptoms increased with a gestational period. Conclusion. The reason for the lack of pregnancies in almost half of the patients with AS is associated with their subjective fear of the negative impact of the disease and therapy on a child’s future health. In AS versus a healthy life period, surgical deliveries are performed more frequently. The neonatal outcomes of pregnancies do not differ before and after the onset of AS.

The article presents the data of international registries and cohort studies of systemic lupus erythematosus (SLE). It justifies the purpose and objectives of the international registry of SLE patients, a Eurasian cohort (RENAISSANCE), which was launched in 2012 and amalgamated the leading rheumatology centers of the Russian Federation (V.A. Nasonova Research Institute of Rheumatology; Department of Rheumatology, Pacific State Medical University), Kazakhstan (Department of Rheumatology, S.D. Asfendiyarov Kazakh National Medical University), and Kyrgyzstan (Academician M. Mirrakhimov National Center for Cardiology and Therapy), which mainly concentrate patients with the acute course of this disease. The first data of the registry are given.

Neonatal lupus (NL) is a syndrome diagnosed in neonatal infants, whose mothers frequently suffer from autoimmune rheumatic diseases, manifested by two major signs: skin lesion and cardiac lesion. The paper gives data from the history of a description of the syndrome, as well as current ideas on its pathogenesis, considers both typical and rarer clinical manifestations of the disease, and presents approaches to NL therapy and prevention.

Rheumatoid arthritis (RA) is a chronic disease that may affect women of childbearing age. The occurrence of their pregnancy is frequently accompanied by the lower activity of RA and its exacerbation may occur postpartum. Regular disease activity monitoring during pregnancy and postpartum is a necessary condition for adequate therapy correction in this category of patients. Objective: to determine an optimal method to assess RA activity during pregnancy and postpartum Subject s and methods. Thirty-two pregnancies were prospectively followed up during each trimester and within 12 months postpartum in 29 women with RA (according to the 1987 ACR criteria) who had been examined at the V.A. Nasonova Research Institute of Rheumatology from February 2011 to August 2014. Results. Comparison of different methods to assess RA activity demonstrated that DAS28-ESR shows overrated estimates due to a physiological ESR elevation during pregnancy. CDAI and SDAI are greatly affected by a patient's subjective assessment of his/her health, which may be overestimated during pregnancy and in the first month after giving birth. DAS28-CRP(3) recommended in the world literature to assess RA activity in pregnant women showed the same changes as DAS28-CRP(4). The latter is widespread in international studies and has been validated in a large number of patients. Thus, DAS28-CRP(4) may be considered optimal to monitor RA activity during pregnancy and postpartum.

Objective: to develop an education program for patients with rheumatoid arthritis (RA) and to evaluate its efficiency. Subjects and methods. The study included 43 patients with RA: 23 study group patients were trained according to an education program (Rheumatoid Arthritis Health School), 20 patients formed a control group. The education program consisted of 4 daily 90-min studies. The MDHAQ (R798—NP2) questionnaire was used to determine DAS 28, HAQ, RAPID 3 scores at baseline and following 6 months. Results. Six months after education, the study group showed reductions in DAS 28 by 1.33+0.26 scores (р < 0.05), HAQ by 0.91±0.54 (55.2%; р < 0.01), and RAPID 3 by 5.96±0.92 (49.9%; р < 0.01), anxiety level by 0.86±0.32 (54.4%; р < 0.05), depression by 0.87±0.61 (53.4%; р < 0.05), fatigability by 3.39±1.17 (47.5%; р < 0.05); sleep improved by 0.81±0.36 scores (54.7%; р < 0.05). Six months following education program participation, there was significantly more frequently a good DAS 28 response to treatment according to the EULAR criteria (52.2% versus 30.0% in the control group; р < 0.05), and the number of patients who reported health improvement increased by 8.5 times (р < 0.01). The changes in the control group were less pronounced, which determined statistically significant differences between the groups in most indicators (р < 0.05). Conclusion. The education program improves functional capacities and psychological status, assists in controlling the disease activity, and enhances the quality of life in patients with RA.

The data available in the literature on experience in using antimalarial drugs in the treatment of systemic lupus erythematosus are summarized. A major emphasis is placed on therapy with hydroxychlorochine (plaquenil) versus chlorine. Possible mechanisms of action of the drug and its effect on the course of the disease itself and concomitant abnormalities are described. Data on the toxicity of the drug and its safe use in pregnancy and lactation are also discussed

Objective. To assess change of annexin-5 antibodies (AA5) level and AA5 influence on gestation outcome in pregnant women with systemic lupus erythematosus (SLE). Material and methods . 15 pregnant women with SLE who fulfilled 1997 ACR criteria (4 of them with concomitant antiphospholipid syndrome – APS) were included. Median age of pts was 28,0 (23- 33) years, median SLE duration – 4,0 (3-9) years. SLEDAI activity score at the beginning of gestation was 2 (2-11). All but one pts received metypred from 2 to 20 mg/day. The women were examined in every trimester of gestation. AA5 and anticardiolipine antibodies (ACLA) were evaluated with immunoenzyme assay. Results. AA5 elevation was revealed in 7 women (group 1): 6 of them were only IgG AA5 positive, 1 had both IgG and IgM AA5. Isolated IgM AA5 elevation was absent. 4 pts had borderline IgG AA5 values (from 5,3 to 7,4 U/ml). 3 pts had respectively 9,6, 12,1 and 168,5 U/ml. The last pt was also positive for IgM AA5 (till 14,4 U/ml). AA5 elevation was more frequent and more prominent during the II trimester of gestation. 8 pts with SLE (group 2) did not have AA5 elevation. 11 from 15 gestations ended with birth of viable baby, the rest 4 had unfavorable outcome. Median terms of delivery did not differ in both groups and came to 36 weeks. 3 pts with normal AA5 and 1 pt with elevated AA5 had gestation lost. 3 from these 4 pts were ACLA positive and APS was earlier diagnosed in 2 from them. Conclusion. Almost half of pregnant women with SLE (7 from 15) had AA5 elevation mainly during the II trimester of gestation. Unfavorable gestation outcomes were not associated with AA5 elevation. Possibly low levels of AA5 positivity and small sample size could influence the results.

Rheumatoid arthritis (RA) frequently affects women of child-bearing age, which determines long-standing interest in studying the mutual impact of pregnancy and RA. The first observation described about 80 years ago has shown decrease of disease activity in the absolute majority of pregnant women. Later prospective studies have demonstrated that only 48–66% of women have clinical improvement during pregnancy, postpartum exacerbation of RA develops in 70% of cases, and most patients need drug therapy. Objective: to assess changes of RA activity with DAS28-CRP during pregnancy and postpartum; to examine the impact of RA activity during early pregnancy on further course of the disease; and to determine drug therapy requirement in pregnant women with RA. Subjects and methods. Thirty-two pregnancies were prospectively followed up during each trimester and within 12 months postpartum in 29 women with RA who fulfilled the 1987 ACR criteria and had been examined at the V.A. Nasonova Research Institute of Rheumatology from February 2011 to August 2014. Results and discussion . 46% of the patients with RA showed reduction of disease activity during pregnancy. Exacerbation of RA was observed in 75% of the patients within 12 months at 1.5 months postpartum on average. In patients who were in remission and had low disease activity during early pregnancy, activity of RA throughout pregnancy and 1 month postpartum remained lower than that in those with moderate and high activity in the first trimester (p = 0.0008–0.04). A similar trend was also seen in patients without active arthritis at the moment of conception (according to survey data). In 23 (71.9%) patients with signs of disease activity during pregnancy, anti-inflammatory therapy was enhanced and DAS28-CRP decreased (p = 0.008) while it tended to increase in the remaining 9 (28.9%) patients with low disease activity who did not received medication. After delivery, patients with high and moderate disease activity showed earlier improvement (p = 0.008), as they more early resumed therapy with diseasemodifying antirheumatic drugs (DMARDs) and biologics than those who were in remission and had low disease activity during pregnancy. In the latter, a tendency for higher disease activity persisted for 3 months after delivery. Disease activity during the first-to-third trimester was significantly higher in 12 (37.5%) patients who had conceived while taking DMARDs or biologics and urgently withdrew them due to their pregnancy than in 20 (62.5%) cases when DMARDs and/or biologicalshad not been used or had been discontinued in advance when they started planning pregnancy (p < 0.04). Conclusion . Remission or low activity of RA during early pregnancy is a predictor for low disease activity and for minimizing drug therapy to the point of its refusal throughout pregnancy. Without drug therapy, RA activity may tend to increase. A postpartum RA exacerbation is also noted in patients who have been in remission and had low RA activity antepartum. Dramatic withdrawal of DMARDs or biologics because of an unplanned pregnancy contributes to higher RA activity just in the first trimester of pregnancy. Pregnancy should be planned, by choosing stable anti-inflammatory therapy in advance.

The start of the new millennium is marked by a substantial progress in the development of rheumatology: pathogenesis of many rheumatic diseases (RDs) was more deeply studied; their diagnostic criteria validated; disease activity indices worked out; the concepts of remission and exacerbation introduced; much attention has been given to the investigations of quality of life in patients. The possibility of pharmacotherapy for immunoinflammatory RDs was extended by the advent of biological agents (BA). The treatment strategy for RDs was also changed. The treat-to-target concept was put forth for rheumatoid arthritis in 2010 and for ankylosing spondylitis later. The project of treat-to-target concept in systemic lupus erythematous (SLE) was launched on the initiative of the world’s leading rheumatologists in January 2013. The result of their work is the treat-to-target-in-SLE recommendations published in 2014 and formulated as 4 basic principles and 11 general recommendations. The purpose of this publication is to provide general characteristics of the basic provisions of the principles and recommendations with commentaries of leading experts discussing characteristics of SLE in the Russian Federation and some debatable and unsolved problems.

Rheumatoid arthritis (RA) generally starts at the age when many women have already become mothers; however, it may occur in childhood or adolescence. Furthermore, there has been recently a women’s tendency to plan pregnacy for a more mature age, which necessitates a discussion about gestation in this disease. Investigation of mechanisms pregnancy can influence the development of RA both in the gestation and long-term periods is of important theoretical and practical value. The results of these investigations may be used to develop new treatments for RA and management tactics for patients during pregnancy and lactation. The aper gives the data available in the literature on fertility in RA, impact of pregnancy on its activity and that of RA on the course and outcomes of gestation, as well as current ideas on lactation and use of oral contraceptives in RA. Particular attention is given to drug therapy in pregnant and breastfeeding women with RA: groups of anti-rheumatic drugs are considered in detail in relation to the safety of or a potential risk from their use. A therapeutic algorithm and recommendations for pregnancy planning and a follow-up of patients with RA during gestation are proposed.