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Objective:to determine the incidence of insulin resistance (IR) in patients with rheumatoid arthritis (RA) and to assess the relationship of IR to blood lipid profile changes and the presence of metabolic syndrome (MS).Subjects and methods.The investigation enrolled 47 RA patients (41 women and 6 men) without a history of diabetes mellitus (DM) and with normal fasting glucose levels during examination. The patients' median age was 56 [39; 62] years; disease duration – 6 [5; 14] years. Most of the patients had low (40.4%) or moderate (42.6%) RA activity (DAS28). IR was diagnosed using the Homeostastic Model Assessment of Insulin Resistance (HOMA-IR) index 2.77. The presence of MS was assessed by the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATPIII) criteria and the International Diabetes Federation (IDF) criteria.Results and discussion.The median HOMA-IR value in RA patients was 1.7 [1.1; 3.2]. The HOMA-IR index correlated with age (r=0.3; p=0.04), body mass index (r=0.6; p3.0 (40.0 and 6.3%, respectively; pConclusion.More than 30% of RA patients without DM have IR (HOMA-IR ≥2.77). IR in RA is associated with obesity, elevated blood TG levels, and a proatherogenic lipid profile. The use of the criteria for MS could not always allows suspect IR in patients with RA.

Objective: to clarify the relationship of adiponectin and leptin to the signs of disease activity and the levels of pro- and anti-inflammatory cytokines in patients with early rheumatoid arthritis (RA).Subjects and methods. The investigation enrolled 27 RA patients who met the 2010 ACR/EULAR classification criteria and had never received glucocorticoids (GCs) or disease-modifying antirheumatic drugs. The median age of the patients was 56 [46; 64] years; the duration of the disease was 8 [6; 15] months. All the patients had moderate or high RA activity according to DAS28. The majority of the patients were seropositive for rheumatoid factor (88.9%) or anticyclic citrullinated peptide antibodies (96.3%). A control group included 30 gender-, age-, and body mass index (BMI)-matched people without inflammatory arthritis. Enzyme immunoassay was used to estimate the concentrations of adiponectin and leptin; XMAP multiplex assay was applied to measure the levels of interleukin-1β (IL-1β), IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12, IL-13, IL-15, IL-17 and macrophage inflammation proteins (MIP), such as MIP-1α and MIP-1β.Results and discussion. In RA patients, adiponectin concentrations were higher (pConclusion. In early RA, there was a lower leptin synthesis and a higher adiponectin production. The correlations between the levels of adipocytokines, IL-17, and MIP1β, on the one hand, suggest that adipose tissue has an impact on systemic inflammation and, on the other, confirm that proinflammatory cytokines are involved in the development of insulin resistance and obesity.

The literature review deals with various aspects of the concurrence of rheumatoid arthritis (RA) and autoimmune thyroid diseases (Hashimoto's thyroiditis and Graves' disease). It discusses the prevalence, genetic predisposition, similarity of pathogenesis and clinical symptoms, as well as the ability of organ-specific autoantibodies (anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies) and hypothyroidism to affect the course of RA and the risk of cardiovascular complications.

Objective : to investigate the prevalence of traditional risk factors (RFs) and to determine a 10-year risk for type 2 (T2) diabetes mellitus (DM), by using the Finnish Diabetes Risk Score (FINDRISC) in patients with rheumatoid arthritis (RA). Subjects and methods. The investigation enrolled 418 RA patients without a history of DM. The median age of the participants was 54 [41; 63] years; the median disease duration was 6 [2; 12] years. Most of the patients were positive for rheumatoid factor (75.6%) and anti-cyclic citrullinated peptide antibodies (77.3%) and had moderate and high RA activity (81.8%). Glucocorticoids (GCs), disease-modifying anti-rheumatic drugs, and biological agents were used in 42.1, 66.7, and 23.9% of the patients, respectively. FINDRISC was used to assess the risk of T2DM. A control group consisted of 100 gender- and age-matched individuals without inflammatory joint diseases or DM. Results and discussion. The most common modifiable traditional RFs in RA were abdominal obesity (AO) (63.6%), overweight (50.7%), and lack of physical activity (70.3%); the non-modifiable RF was age older than 45 years (69.1%). The RA and control groups showed the similar prevalence of RFs, except for AO that was more common in the absence of inflammatory joint diseases (75.0%) (p = 0.03). The number of RFs did not differ in RA patients (median RFs, 4 [2; 5]) and control individuals (4 [3; 5]) (p = 0.23). The moderate risk of developing T2DM in the ensuing ten years was 20.1 and 18.0% in RA patients and control individuals, respectively; the high risk was in 19.6 and 24.0% and the very high risk was in 2.7 and 2.0%, respectively (p > 0.05 in all cases). In RA, there was a weak correlation between the number of RFs and DAS28 (r = 0.10; p = 0.05), RFs and HAQ (r = 0.19; p < 0.01). Examinations detected fasting hyperglycemia (glucose ≥6.1 mmol/l) in 3.8% of the RA patients with a low/slightly increased risk for T2DM and in 16.1% of those with its moderate, high, and very high risks (p < 0.01). The use of GCs did not affect the number of RFs, the distribution of groups at risk for DM, and the frequency of hyperglycemia. These findings can lead to the conclusion that the risk of developing T2DM in RA is associated with a high frequency of modifiable traditional RFs, such as obesity and lack of physical activity. FINDRISC is a simple method to identify RA patients who need lifestyle monitoring and modification, as well as an additional examination to rule out latent T2DM.

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.

The clinical value of the disorders and diseases integrated within the metabolic syndrome (MS) is in the combination of traditional risk factors for cardiovascular diseases (CVD), which significantly accelerates the development of cardiovascular events (CVEs). The detection rate for MS in patients with rheumatoid arthritis (RA) is shown to be higher than in the controls regardless of the diagnostic criteria for MS. At present, there are confusing data on the role of adipokins in RA. Objective: to determine the rate of MS and its components in RA patients and the association of the level of adipokin (adiponectin) with the components of MS in relation to the duration of RA. Subjects and methods: The investigation enrolled 69 RA patients divided into two groups: 1) 34 patients with early-stage (2-year) RA. Results. MS occurred in 12 (17.4%) of the 69 patients with RA. There was central (abdominal) obesity in 37 (53.6%) patients with RA, hypertension in 29 (42%), low high-density cholesterol levels in 20 (29%), hyperglycemia in 11 (15.9%), and hypertriglyceridemia in 10 (14.5%). According to the presence or absence of MS, the patients were divided into 2 groups: 1) 12 patients with MS; 2) 57 without MS. In the patients with RA and MS, the duration of the disease was shorter; DAS28 and CDAI were higher than in those without MS: 15.4 [7; 24] months versus 51.8 [6; 72] months; DAS28 was 5.8 [4.9; 6.7] scores versus 5.1 [4.5; 5.8] scores; CDAI: 34.8 [21.8; 41.4] scores versus 24.2 [18; 31] scores, respectively (p < 0.05 in all cases). The serum level of adiponectin was lower: 13.1 [5.7; 10.7] ng/ml versus 20.6 [6.9; 30.9] ng/ml in the patients with RA and MS as compared to those without MS; but there were no significant differences. In the patients with early-end RA, the rate of MS was twice higher than that in those with end-stage RA; however, the differences were statistically insignificant (p = 0.1). The components of MS were encountered with the same frequency in early- and end-stage RA. The early RA group showed a correlation between SDAI (r = -0.34), body mass index (r = -0.41), high-density lipoprotein cholesterol (r = 0.33), erythrocyte sedimentation rate (r =-0.35), and adiponectin. The >2-year RA group displayed no relationship between adipokins, activity markers, and metabolic disturbances. Conclusion. The preliminary results suggest the high rate of MS in patients with a high level of early RA disease activity untreated with disease-modifying antirheumatic drugs, thus determining the high risk of CVEs just at disease onset. The role of adiponectin in the development of MS, CVEs in rheumatic diseases remains to be solved, which is the subject of further investigations. It is possible that normalization of adiponectin concentrations may promote reductions in the incidence of CVD, mortality rates due to atherosclerosis-induced CVEs, and the prevalence of MS and insulin resistance.

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.