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The transformation of a subnanosecond ultrawideband electromagnetic pulse (UWB EMP) in a large-volume transparent plasma has been demonstrated experimentally using a large-scale KROT plasma device. The column of the plasma generated in the device chamber has a length of more than 4 m and a diameter of more than 1 m. This allows one to implement the regime of quasiuniform ionization, which is necessary to simulate UWB EMP propagation through the ionosphere. It is shown that the length of the wave propagation path in the plasma is sufficient for dispersion transformation of the pulse retaining the envelope of its frequency spectrum.

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

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

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

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

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

According to the World Health Organization (WHO), worldwide, annual influenza epidemics lead to approximately 3–5 million cases of severe forms of the disease and 250–500 thousand deaths. The problem of the course and outcomes of influenza is also relevant for patients with immunoinflammatory rheumatic diseases, including spondyloarthritis (SpA). However, data on the immunogenicity, efficacy and safety of influenza vaccines in patients with SpA are limited.The aim of the work was to study the immunogenicity, efficacy and safety of the trivalent inactivated influenza split vaccine in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA), observed at the V.A. Nasonova Research Institute of Rheumatology.Materials and methods. 94 people were included in the study: 28 patients with AS, 14 patients with PsA, 52 patients in control group (СG) without immunoinflammatory rheumatic diseases. Vaccination with a trivalent inactivated influenza split vaccine was carried out over three consecutive epidemic seasons: 2020–2021, 2021–2022, 2022–2023. The majority of patients (71,4%) received immunosuppressive therapy. The trivalent inactivated influenza split vaccine was administered in an amount of 1 dose (0.5 ml) intramuscularly against the background of anti-rheumatic therapy, regardless of the activity of the main IVR. The level of antibodies (AT) of class G to hemagglutinin (HA) of influenza A (H1N1), A (H3N2) and B viruses was determined using enzyme immunoassay systems manufactured by PPDP LLC (St. Petersburg, Russian Federation) before vaccination, 1–3 (on average, 1,6±0,8) and 6 months after it. The clinical efficacy and safety of trivalent inactivated influenza split vaccine were also evaluated, including the effect on the activity of AS and PsA according to the dynamics of BASDAI and DAPSA indices.Results. At the second and third visits after vaccination the level of AT, determined in units of optical density, to HA of influenza A (H1N1), A (H3N2) and B was significantly higher compared to baseline values. During follow-up, influenza or flu-like disease according to WHO criteria were absent in 37 patients. In general, there was no negative effect of vaccination on the activity of the underlying disease. The frequency of postvaccinal reactions in patients and in СG was comparable.Conclusions. The obtained results of the study indicate sufficient immunogenicity, clinical efficacy and safety of trivalent inactivated influenza split vaccine in patients with AS and PsA.

According to the currently available data from large cohort studies, patients with immuno-inflammatory rheumatic diseases (IIRDs) are at increased risk of infectious complications, including influenza, compared to the general population. Vaccinations are a critical component of their care. However, data on the immunogenicity, efficacy, and safety of influenza vaccines in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) receiving modern anti-rheumatic drugs are limited.The aim of the study was to investigate the immunogenicity, efficacy, and safety of the trivalent inactivated influenza split vaccine in patients with RA, AS and PsA, observed at the V. A. Nasonova Research Institute.Materials and methods. The open prospective comparative study included 247 patients: 74 patients with RA, 62 patients with AS, 14 patients with PsA, as well as 97 people without IIRDs who comprised the control group (СG). The patients were selected over six epidemic seasons: 2016–2017, 2017–2018, 2018–2019, 2020–2021, 2021–2022, and 2022–2023. The majority of patients (78,7%) received immunosuppressive therapy at the time of inclusion in the study. The trivalent inactivated influenza split vaccine was administered in an amount of 1 dose (0,5 ml) intramuscularly against the background of anti-rheumatic therapy, regardless of the activity of the main IIRD. The level of class G antibodies to hemagglutinin (HA) of influenza A (H1N1), A (H3N2), and B viruses was determined in optical density units (OD units) using an enzyme-linked immunosorbent assay (PPDP LLC, St. Petersburg) before vaccination, 1–3 and 6 months after vaccination. The clinical efficacy and safety of the trivalent inactivated influenza split vaccine were also evaluated, including the effect on the course of RA, AS, and PsA according to the dynamics of disease activity indices.Results. After vaccination, a significant increase in the level of antibodies was observed in patients with RA, AS, and PsA. At the second visit after vaccination the level of antibodies, determined in units of optical density, to HA of influenza A (H1N1), A (H3N2) and B was significantly higher compared to baseline values. By the third visit (6 months after vaccination), there was a slight decrease in the immune response, but the level of antibodies remained significantly higher than the initial level for all strains of influenza virus, with the exception of influenza B in the group of patients with RA. During follow-up, influenza or influenza-like illness was absent in 98,6% of patients who completed the study. No negative effect of vaccination on the activity of the underlying IIRD was noted. The frequency of post-vaccination reactions in patients with IIRDs and in the СG was comparable.Conclusions. The results obtained in the study indicate sufficient immunogenicity, clinical efficacy, and safety of the trivalent inactivated influenza split vaccine in patients with RA, AS, and PsA.

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

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

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

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

Over the past two years since the beginning of the COVID-19 pandemic, many patients have experienced symptoms of post-Covid syndrome (PCS), which are often found in rheumatic diseases, which can cause diagnostic difficulties for physicians. The article presents epidemiology, a modern view on pathogenesis and possible biomarkers of PCS. As part of the differential diagnosis, the clinical and laboratory manifestations of PCS are considered. The feasibility of COVID-19 vaccination is emphasized and its role in the development of PCS is discussed. Current drug therapy approaches and rehabilitation programs are described.

Objective: to study the efficacy and safety of the Gam-COVID-Vac vaccine in patients with immunoinflammatory rheumatic diseases (IRD) in a prospective study.Material and methods. The study included 42 patients with IRD and 57 individuals without IRD (control group) who received at least one component of Gam-COVID-Vac. Immunization with the first component of the vaccine was carried out from March 25th to August 1st, 2022, the second – 3 weeks after the first dose. On days 1, 3 and 7 after administration of the first and second components, the study participants provided information on adverse events (AEs) by telephone. All subjects were examined by a rheumatologist 1, 3 and 6 months after complete immunization. The observation period after immunization with the second dose was 6 months.Results and discussion. 42 patients received the first component of the vaccine, and 39 patients received two components. In the control group, 57 subjects were immunized with two components of the vaccine. 30–180 days after vaccination with two components of Gam-COVID-Vac, 3 (7.7%) patients were diagnosed with SARS-CoV-2 infection, which was confirmed by polymerase chain reaction. In all cases, a mild course of COVID-19 without signs of pneumonia was observed. There were no cases of COVID-19 in the control group. After immunization with the first component, a combination of at least one local and one systemic AE (SAE) was documented in 28.6% of patients with IRD and 33.3% of individuals in the control group (p>0.05). No AEs were recorded in 42.9% and 36.8% of cases respectively (p>0.05). After vaccination with the second component, a combination of ≥1 local AE and SAE was recorded in 15.4 % of patients with IRD and 22.8% of individuals in the control group (p>0.05). No AEs occurred in 71.8% and 56.1% of cases respectively (p>0.05). In 10.3% of patients with IRD and 12.3 % of those without IRD (p>0.05), a combination of local and systemic AEs was recorded after the introduction of both first and second components. No AEs were observed in 35.9% and 28.1% of cases, respectively (p>0.05). The overall rate of IRD exacerbations was 4.8%.Conclusion. Based on the available data, vaccination against COVID-19 appears to be effective and quite safe in patients with IRD.

Objective: to evaluate the completeness of screening for hepatitis B virus (HBV) infection in HBsAg-positive patients admitted to a rheumatology hospital and to follow the history of HBV reactivation/seroversion during antirheumatic therapy. Material and methods. The results of initial and repeated (if applicable) hospitalizations were analyzed in 80 patients with rheumatic diseases (RD), including 55 (69%) women and 25 (31 %) men, with Australian surface antigen (HBsAg), admitted to the V.A. Nasonova Institute of Rheumatology from January 1, 2020 to July 20, 2022 (30 months). Results and discussion. The total number of hospitalizations to the clinic during the observation period, including repeat admissions, was 13,681. The number of hospitalizations in 80 patients with HBV infection during the observation period, including repeat admissions, was 144, of which for systemic vasculitis – 6 (8 %), other systemic connective tissue diseases – 16 (20 %), osteoarthritis and post-traumatic changes of joints – 14 (15 %), inflammatory joint diseases – 42 (54 %). Cases of HBV reactivation/seroverion, both in anamnesis and during observation, were detected in 9 (11 %) patients, and most frequently (n = 5) they were registered during methotrexate therapy. Conclusion. HBV infection in patients with RD leads to significant difficulties in the selection of drug therapy, due to the risk of reactivation of the infection. The results obtained indicate incomplete screening of patients with RD for HBV infection during the preclinical phase. Further investigation is needed to develop clear recommendations for the management of patients with RD infected with HBV.

The aim of the study was to assess frequency and severity of COVID-19 in patients with rheumatic diseases (RD) who were on inpatient treatment at the V.A. Nasonova Research Institute of Rheumatology. Patients and methods. The study included information on the presence or absence of COVID-19 in the medical history of 6911 patients with immunoinflammatory RD (IIRD) and 362 patients with osteoarthritis (OA) who were on inpatient treatment at the V.A. Nasonova Research Institute of Rheumatology from September 21, 2021 to April 28, 2023. Results. The incidence of COVID-19 in the analyzed IIRD was significantly higher compared to OA (p

The review presents the recommendations of the American College of Rheumatology on vaccination of patients with rheumatic diseases. The indications for vaccination against major infections and the tactics of immunization with inactivated vaccines are highlighted. The possibility of safe vaccination with any disease activity and simultaneous administration of several vaccines is emphasized. The conditions of immunization with live attenuated vaccines are considered. The principles of vaccination of children born to mothers treated with biological drugs, as well as recommendations for the contacts of rheumatological patients with vaccinated population are reflected. Emphasis is placed on the need for joint decision-making by the rheumatologist and the patient.

Objective: to study the course of COVID -19 and post-covid syndrome (PCS) in patients with rheumatoid arthritis (RA).Material and methods. The study included 32 adult patients with a confirmed diagnosis of RA, who met ACR/EULAR criteria. All patients had COVID-19. Material for analysis was obtained by means of a questionnaire developed at the V.A. Nasonova Research Institute of Rheumatology, which patients completed during their interview with the researcher.Results and discussion. The study group consisted mainly of women (n=29, 90%). The mean age of the patients was 50.75±16.48 years. Among the clinical manifestations of COVID-19, weakness/fatigue (90.6%; p

Objective: To investigate the frequency, structure, and risk factors of comorbid infections (CI) in patients with spondyloarthritis (SpA).Material and methods. The study included 332 patients with SpA. Patients were interviewed by the investigating physician, and additional information was obtained from medical records.Results and discussion. Respiratory tract (RT) and ear, nose, and throat (ENT) infections ranked first in the structure of CI. Exacerbation of SpA after CI was found in 42% of patients, and more severe CI against the background of SpA was found in 83 patients. 63 cases of severe CI (SCI) were documented, 63.5% of which were infections of the RT and ENT organs. Predictors for the development of lower RT (LRT) and ENT organ infections were the use of biologic disease-modifying antirheumatic drugs (bDMARDs) in general (odds ratio, OR 2.018; 95% confidence interval, CI 1.221-3.335; p=0.006 and OR 1.761; 95% CI 1.1-2.819, respectively; p=0.018) and tumor necrosis factor-α (TNF-α) inhibitors in particular (OR 2.376; 95% CI 1.417-3.983; p=0.001 and OR 1.833; 95% CI 1.123-2.994; p=0.015), and disease duration of more than 5 years (OR 1.774; 95% CI 1.034—3.042; p=0.037 and OR 2.22; 95% CI 1.378-3.576; p=0.001). The risk of developing LRT infection was higher in the presence of chronic lung disease (OR 3.673; 95% CI 1.602-8.425; p=0.002) and Charlesson Comorbidity Index ≥1 (OR 2.381; 95% CI 1.439-3.94; p=0.001), risk of developing ENT organ infections - with the use of >1 bDMARD (OR 2.4; 95% CI 1.199-4.804; p=0.013) and duration of methotrexate therapy over 5 years (OR 2.478; 95% CI 1.053-5.831; p=0.038). Risk factors for the development of SCI were the use of bDMARDs in general (OR 1.941; 95% CI 1.063-3.545; p=0.031) and TNFα in particular (OR 2.246; 95%, CI 1.218-4.139; p=0.01).Conclusion. The problem of CI in SpA is of great importance. The vast majority of patients with SpA should be vaccinated against pneumococcal infection and influenza.

During the three years that have passed since the beginning of the COVID-19 pandemic, many new fundamental and medical problems have been discovered regarding the relationship between the viral infection and many common chronic non- infectious diseases. Among the latter, an important position is occupied by immuno-inflammatory rheumatic diseases (IIRD), which include rheumatoid arthritis (RA). To date, there is no doubt that patients with RA are at risk for SARS-CoV-2 infection, a severe course of infection that necessitates hospitalization and death. The article presents current data on the course and outcomes of COVID-19 in patients with RA. The literature and own data on postcovid syndrome in this group of patients are presented. The necessity of vaccination against SARS-CoV-2 in patients with IIRD, including those with RA, was substantiated. The prospects for further study of the features of COVID-19 in patients with RA are outlined.

Relevance. The contradictory and ambiguous situation that has developed in modern sports requires an expanded range of scientific research in the field of axiology and psychology of sports. The existing facts of negative manifestations in sports determine the search for socio-cultural and axiological features of the social orientation of athletes. The purpose of the study was to conduct a sociocultural and axiological analysis of the social orientation of athletes. Research methods: The methodological basis of the study was socio-philosophical, ethical-philosophical, cultural, macro-psychological and axiological characteristics of sports as a social institution, socio-psychological aspects of sports and sports activities; ideas of multidimensionality and systemic development of the social orientation of an athlete. When conducting a theoretical study, a theoretical analysis of the literature, the study of dissertation research, regulatory documents and scientific articles, generalization and systematization of the results obtained were used. The results of the study. It is substantiated that the phenomenon of sport, which demonstrates a general social orientation, is the object of a wide range of cultural, philosophical, psychological, sociological scientific works. The analysis made it possible to identify socio-cultural and axiological factors that determine the social orientation of athletes.

Glucocorticoids (GCs) are one of the most commonly used drugs for the treatment of rheumatoid arthritis (RA), the effectiveness of which is beyond doubt. The review considers current literature data on the safety of GCs use, as well as the most common adverse events associated with such therapy. Most authors point to an increased risk of complications with an increase in the daily dose and/or duration of GCs treatment. At the same time, a safe dose of GCs has not been determined. Probably, the optimal tactic is the selection of an individual dose of GCs in each individual case, taking into account the activity of RA and the spectrum of comorbid conditions. In this case, the minimum effective doses and short courses of GCs should be used, regular monitoring of clinical and laboratory parameters should be carried out in order to detect adverse events early.

In modern conditions, the problem of bacterial arthritis (BA) is very relevant. The leading etiological agent of BA is Staphylococcus aureus. The frequency of deaths in BA has not changed significantly over the past 25 years and is 5-15%. The article highlights current data on the etiology, pathogenesis, clinical picture, diagnosis of BA. Indications for open surgical drainage of an infected joint are presented. The main schemes of empirical and etiotropic antibacterial therapy of BA are presented.

The aim of the study was to assess the safety of the combined vector vaccine Gam-COVID-Vac (Sputnik V) and to determine the risk factors for the development of adverse events in patients with immuno-inflammatory rheumatic diseases (IIRD). Patients and methods. A single-stage study of patients with IIRD who were on inpatient treatment or who applied to the consultative and diagnostic center of the V.A. Nasonova Research Institute of Rheumatology was conducted, who received both components of the Sputnik V vaccine. The control group included immunized persons without IIRD. All participants were interviewed by a research doctor with filling out a unified questionnaire, additional information was obtained from medical documentation. Results. The study included 325 patients with IIRD and 138 healthy controls. After vaccination with the first component, the number of patients with IIRD, in whom the development of local and systemic adverse events (AEs) was noted, was significantly lower compared to the control (20.3% and 38.4% respectively; p

Infections remain one of the main causes of morbidity and mortality in patients with immuno-inflammatory rheumatic diseases. Objective – to study the efficacy, immunogenicity and safety of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (AРS). Materials and methods. 91 patients were included in the study: 78 with SLE, of which 18 (23 %) – with secondary AРS, 13 – with primary AРS. 85 patients received immunosuppressive therapy, including 30 – genetically engineered biological drugs (bDMARD); 23 – anticoagulants. PPV-23 was administered subcutaneously, patients were observed for a year after vaccination. Results. Local reactions were observed in 49% of patients with SLE and secondary AРS, in 23% of patients with primary AРS. General reactions were noted in isolated cases, were short-term and did not require additional prescriptions. During the follow-up period, no exacerbations of SLE, relapses of thrombosis and thromboembolism associated with vaccination were detected; no development of new autoimmune diseases was registered. 10 (13%) patients with SLE were immunized against the background of high activity of the disease, no adverse reactions were recorded. In some patients, a transient increase in a-DNA and ANF was observed during the year without signs of exacerbation of the disease. 56% of patients with SLE and secondary AРS, 15.4% with primary AРS were “responders” to the vaccine. There was no negative effect on the immune response of the dose of GC >10 mg/day, age, duration and activity of the disease. With the treatment of bDMARD, a full-fledged vaccine response was recorded much less frequently than with standard therapy (38% and 67.4%, respectively; p=0.01). After vaccination, there was a significant decrease in the number of lower respiratory tract infections (LRTI) (p=0.0001), including community-acquired pneumonia (PN) (p=0.03) and acute bronchitis (p=0.04), ENT infections (p=0.001). In the treatment of rituximab (RTM), compared with belimumab (BLM), a greater number of LRTI was observed, mainly due to PN. After vaccination on RTM therapy, the number of INDP in general (p=0.008) and PN in particular (p=0.03) decreased, isolated cases of LRTI and ENT organs were recorded on BLM therapy. Within 4–6 years after vaccination, 30 patients with SLE retained the clinical effect of vaccination, while immunogenicity decreased to 18%. Conclusion. Safety, sufficient immunogenicity, and clinical efficacy of PPV-23 in patients with SLE and AРS have been shown. The use of bDMARD reduces the vaccine response. Immunization performed prior to or during treatment with bDMARD lasting

In modern rheumatology, comorbid infections have a significant impact on morbidity and mortality, especially in immuno-inflammatory rheumatic diseases (IIRD). One of the ways to solve this problem is the study and active use of various vaccines. This article analyzes the recommendations for vaccination of patients with acute respiratory infections, proposed in 2022 by experts of the American College of Rheumatology (ACR). The safety and immunogenicity of vaccination associated with the prevention of various infections in patients with IVR are discussed. It is emphasized that the decision to suspend taking the drug before or after vaccination should be made taking into account the existing IIRD, its activity and the risk of vaccine-controlled infection. A key component of any vaccination strategy (especially for conditional recommendations) is decision-making together with the patient. The main directions of future research on the problem under consideration are outlined.

The problem of comorbid infections in rheumatology still remains relevant. Against the background of immunosuppressive/immunomodulatory therapy of immuno-inflammatory rheumatic diseases (IIRD), chronic and opportunistic infections (COI) often develop. Some of these infections can be prevented by performing timely screening procedures and preventive measures. A group of experts from the European Alliance of Rheumatology Associations (EULAR) has prepared recommendations on screening procedures and prevention measures for the most common COI (tuberculosis, chronic viral hepatitis B and C, infections caused by the human immunodeficiency virus and Herpes zoster, pneumocystis pneumonia) within the framework of the IIRD. This article presents the main provisions of this document. The need for periodic review of screening and preventive procedures is emphasized as new scientific data are accumulated.

In rheumatology, the problem of infectious pathology is quite acute. This is primarily due to the participation of various infectious agents in the development of immuno-inflammatory rheumatic diseases (IIRD), in which microorganisms play a trigger role, triggering the immunopathological mechanisms of inflammation. Vivid examples of such diseases are acute rheumatic fever and reactive arthritis. The infectious etiology of Lyme disease has been proven. An equally difficult task is the fight against comorbid infection (CI), which often complicates the course of many IIRD due to a violation of the immune status caused by both the background disease and the use of immunosuppressive drugs. The predominance of respiratory tract lesions in the structure of CI in patients with IIRD makes it necessary to use influenza and pneumococcal vaccines in them, since the risk of deaths from these infections among these patients is quite high. During the development of the COVID-19 pandemic, which has become a challenge to all mankind, a large number of new fundamental and medical problems have been revealed concerning the relationship between viral infection and many widespread chronic non-communicable diseases, among which IIRDs occupy an important position. As one of the methods of combating the current COVID-19 pandemic, great hopes are pinned on the widespread use of vaccination. The possibility of using mo noclonal antibodies for pre-exposure prophylaxis of COVID-19, including in patients with IIRD, is discussed.

At the present stage of development of rheumatology, much attention is paid to the problem of comorbid infections, which have a significant impact on mortality and mortality, especially in immuno-inflammatory rheumatic diseases (IIRD). The active introduction into clinical practice of innovative drugs, the action of which is aimed at specific components of the pathogenesis of IIRD, has led to an increase in the risk of developing infections of various nature and localization, including chronic and opportunistic (COI). This article analyzes the recommendations for screening and prevention of COI in adult patients with acute respiratory infections, proposed in November 2022 by experts of the European Alliance of Rheumatology Associations (EULAR). It is noted that these recommendations should be considered through the prism of national guidelines that take into account regional risk factors, features of the course, diagnosis, therapy and prevention of СOI. At the same time, it seems absolutely justified to periodically review screening and preventive procedures as new scientific data accumulate. Despite the importance of a multidisciplinary approach and the need for close cooperation with doctors of other specialties, the EULAR working group emphasizes the central role of a rheumatologist in the management of patients with HOI that occur against the background of IIRD and are associated with the received anti-rheumatic therapy.

Pericarditis, a clinical syndrome characterized by inflammation and thickening of the pericardium, is one of the most common forms of inflammatory diseases of the cardiovascular system. The most common and severe complication of acute pericarditis is idiopathic recurrent pericarditis (IRP), which has a poor prognosis associated with the risk of cardiac tamponade and constrictive pericarditis. The pathogenesis of pericarditis is associated with a complex interaction of environmental factors, genetic predisposition, and pathological activation of innate and acquired immunity. Autoinflammatory mechanisms associated with hyperproduction of interleukin (IL) 1 attract particular attention. Standard therapy for pericarditis includes non-steroidal antiinflammatory drugs, colchicine, glucocorticoids, and immunosuppressive drugs. A new direction in the pharmacotherapy of pericarditis is associated with the use of Anakinra (a recombinant non-glycosylated analog of an IL-1 receptor antagonist), which blocks the signaling of IL-1β and IL-1α. The materials of numerous studies are summarized, indicating that Anakinra is an effective drug for the treatment of patients with IRI who are resistant to standard therapy. It is assumed that the wider use of Anakinra, especially in the early stages of pericarditis, will not only improve the prognosis, but also be important for the identification of the autoinflammatory phenotype of IRI and the development of personalized therapy programs.

The incidence of pneumocystis pneumonia (PCP) in patients with rheumatic diseases (RD) continues to increase. This is facilitated by the increasing use of genetically engineered biological agents in addition to the use of cytostatics and glucocorticoids. Mortality due to PCP among patients with RD is extremely high, so the issues of its prevention are relevant. European and American scientists focus on the frequency of detection of PCP and the determination of the proportionality of certain risk factors, while the recommendations for prevention are formulated cautiously. Asian medical communities are unanimous in their opinion about the need to prevent PCP, only the dosage of drugs and the duration of the course of treatment are discussed.

Evaluation of the reasons for discontinuation of therapy with Janus kinase inhibitors (JAKi) may provide a clue to their more effective use.Objective : to analyze the survival of tofacitinib (TOFA) therapy and the reasons for its discontinuation in rheumatoid arthritis (RA) in real clinical practice.Patients and methods. The study included 30 adult patients with RA hospitalized to the V.A. Nasonova Research Institute of Rheumatology from 2018 to 2020 for the biologic disease modifying antirheumatic drugs (bDMARDs) or JAKi treatment. Patients were followed up for 3 years or until treatment with TOFA was discontinued, whichever occurred first.Results and discussion. TOFA was prescribed as the first line therapy in 3 patients. In all these patients, the drug was discontinued for the following reasons: insufficient efficacy (IE) after 2 full years of treatment; adverse reaction (AR); administrative reasons (AdR), i.e. the inability to continue therapy due to the lack of drug supply at the place of residence. 11 patients received TOFA as the second line therapy, in 8 of them the treatment was interrupted: in 4 due to IE, in 3 due to AR (skin allergy) and in 1 due to AdR one year after its initiation. TOFA was prescribed as a third line therapy in 9 patients, in 2 of them the drug was discontinued due to IE and in 3 due to AR (allergic dermatitis in 2, dyspepsia in 1). Another 1 patient refused treatment due to a planned pregnancy. 6 patients received TOFA as the fourth line therapy, 5 of them (83.3%) continued to receive it for more than 3 years. In 1 patient, TOFA was discontinued after 1 month due to the dry cough and shortness of breath onset. In another 1 patient who was prescribed TOFA as the fifth line therapy, treatment was discontinued due to AR (recurrent Herpes zoster).Conclusion. As the results of the study show, no relationship was found between the incidence of AR or IE and clinical and demographic indicators, as well as the frequency of TOFA withdrawal and the line of therapy. At the same time, the shortest duration of retention on TOFA therapy was noted when it was prescribed as a first-line drug.

Background. Patients with autoimmune and inflammatory rheumatic diseases (AIRDs) are at high risk of developing COVID-19. Vaccination is an effective method of preventing this disease, which may be unsafe for patients with AIRDs.The aim of the study is to assess the safety of Gam-COVID-Vac in patients with IVRD in real clinical practice.Material and methods. A cross-sectional study was carried out. The main group consisted of patients with AIRDs, the control group consisted of individuals without AIRDs. All participants were interviewed by the research physician using a unified questionnaire, additional information was obtained from medical records.Results. The study included 222 patients with AIRDs (119 with rheumatoid arthritis, 36 with ankylosing spondylitis, 17 with psoriatic arthritis, 17 with Sjögren's disease, 10 with undifferentiated spondyloarthritis, 8 with systemic lupus erythematosus, 4 with metabolic arthritis, 3 with systemic scleroderma, 3 with systemic vasculitis, 2 with polymyalgia rheumatica, 2 with undifferentiated systemic connective tissue disease, 1 with adult Still's disease) and 111 patients without AIRDs. The number of patients with AIRDs who had a combination of local and systemic adverse events (AE) on the introduction of the first component of the vaccine was significantly less than in the control group (22.1 and 44.1%, respectively, P

Infections and systemic vasculitis (SV) are characterized by mutual influence, which increases the risk of occurrence, aggravates the course and outcome of the disease. The review considers the issues related to both the trigger role of infections in the development of SV and comorbid infections (CI) that complicate the course of the disease. Recognition of the infectious etiology of SV is of great importance, since it requires a comprehensive examination and, if necessary, early and complete etiotropic treatment. Since SV per se and the use of both induction and maintenance immunosuppressive therapy are significant risk factors for secondary CIs, special attention should be paid to the prevention of the latter, including vaccination, primarily against influenza and pneumococcal infections.

Epstein-Barr virus (EBV) belongs to the family of herpesviruses (herpes type 4) and is one of the most common and highly contagious. During the pandemic of a new coronavirus disease, it was found that in patients previously infected with EBV, COVID-19 can cause its reactivation, which is often manifested by the clinic of acute hepatitis. The article presents a clinical case of the development of acute hepatitis in a patient with mixed infection with EBV and SARS-CoV-2 in combination with allergic toxic reaction while taking sulfasalazine prescribed for spondyloarthritis. A feature of this case was the development of severe hepatitis of mixed genesis with a favorable outcome. The importance of adherence to drug monitoring rules for newly prescribed drugs for COVID-19 was emphasized. In severe cases of the disease, the possibility of mixed infection should be taken into account.

Actuality. Data on the prevalence of comorbid infections (CI) in patients with spondyloarthritis (SpA) are few. Risk factors for CI has not been sufficiently studied.Objective. To evaluate the frequency of comorbid infections in patients with spondyloarthritis treated with biological drugs in the form of monotherapy or in combination with DMARD and/or GC.Subjects and methods. The study included 93 patients (55 men, 38 women; average age – 37.0±11.5 years). In 59 patients, AS was diagnosed, in 32 – PsA, in 2 – undifferentiated SpA and SpA associated with nonspecific ulcerative colitis. All patients received biological drugs in combination with DMARD and/or GC or without them. The patients were interviewed by a research doctor with fi lling out a unified questionnaire. Additional information was obtained from medical records.Results. The leading place in the structure of CI was occupied by respiratory tract infections and ENT organs, the 2nd place belonged to herpes viral infections, the 3rd to mycotic infection. Serious CI (SCI) were also represented mainly by injections of respiratory tract infections and ENT organs. A tendency to an increase in the frequency of pneumonia, tuberculosis, acute bronchitis, skin infections, genital organs and mycoses against the background of SpA compared to the period preceding the development of the disease (no significant differences were found) was revealed. 69% of patients noted a more severe course of previously observed CI. 47 patients reported the temporary cancellation of therapy due to the development of CI. 49% of patients have documented exacerbation of SpA. The number of cases of SCI against the background of SpA doubled (p=0.03). There was a positive correlation between the intake of GC and the development of mycoses (r=0.216; p=0.04); between the duration of taking GC and the development of eye infections (r=0.385; p=0.01); between the duration of taking methotrexate and the development of tonsillitis (r=0.25; p=0.03); between taking interleukin 12/23 inhibitors and the development of tonsillitis (r=0.261; p=0.01); between the duration of taking tumor necrosis factor α inhibitors (iTNF-α) and the development of otitis (r=0.287; p=0.01); between the number of consistently used iTNF-α and the development of otitis (r=0.273; p=0.02).Conclusion. The data obtained indicate the relevance of the problem of CI in SpA. Further studies are needed on a larger cohort of patients with an assessment of the effect of therapy on the incidence of CI and the search for risk factors for CI.

Background. The issues of vaccination against the herpesvirus infection are still important in rheumatological practice.This infection often develops in patients receiving immunosuppressive treatment, especially Janus kinase inhibitors (a class-specific adverse reaction) and genetically engineered biologics.The aim of this review is to highlight the current state of the issue of vaccination against Herpes zoster (HZ).Materials and Methods. 37 publications (4 domestic, 33 foreign) were analyzed, in which the mechanisms of pathogenesisand clinical features of herpesvirus infection in patients with immunodeficiency, both with and without immunoinflammatory rheumatic diseases (IIRD), the frequency and variety of post-vaccination reactions, complications and exacerbations of the course of IIRD were considered.Results. There is currently a trend towards reassessment of the rheumatological community's opinion about HZ vaccination, including live vaccine. Literature data allow us to express optimism regarding the effective prevention of herpes zoster in patients who plan to take drugs, primarily from the group of Janus kinase inhibitors. The advantages of the adjuvant recombinant subunit vaccine (Shingrix®) include the possibility of its use against the background of treatment with antirheumatic drugs without significant restrictions, as well as no need to postpone the initiation of the necessary therapy.Conclusions. Publications on the issues of HZ vaccination are few. It is necessary to conduct carefully controlled studies on the efficacy and safety of antiherpetic vaccines with an emphasis on the post-vaccination course of IIRD in patients with rheumatological profile, including in the Russian Federation.

The key role in the development of chronic autoimmune inflammation is played by pro-inflammatory cytokines, in particular, interleukin 6 (IL-6). The introduction into clinical practice of monoclonal antibodies inhibiting IL-6 is a significant event in rheumatology and is currently considered as a promising direction in the treatment of immuno-inflammatory rheumatic diseases. The first inhibitor of IL-6 (IL-6), which entered the practice of rheumatologists, was tocilizumab (TCZ), the second – sarilumab (SAR). Numerous studies have shown the high effectiveness of iIL-6: the use of drugs leads to a rapid decrease in the clinical manifestations of rheumatoid arthritis (RA) and a decrease in laboratory signs of inflammation, contributing to the achievement of low activity or remission, improves the quality of life of patients, and also slows down the X-ray progression of the disease. At the same time, iIL-6 has a satisfactory safety profile. The universal problem of our time – the pandemic of a new coronavirus infection – has led to attempts to use IL-6 in patients with severe and critical disease, since IL-6 plays an important role in the pathogenesis of COVID-19, which is confirmed by the results of numerous studies. However, data on the efficacy and safety of these drugs in COVID-19 are contradictory, which requires conducting larger-scale controlled studies. This review examines the issues of the effectiveness and safety of TCZ and SAR in rheumatological patients and in patients with COVID-19. The review is illustrated with examples from real clinical practice.

In the coming XXI century, infectious diseases still retain their importance both in medical and social terms, this problem is very relevant for rheumatology, where comorbid infections (CI) have a significant impact on both the course of the main immuno-inflammatory rheumatic disease (IIRD) and mortality. One of the leading places in the structure of serious CI in patients with IIRD is occupied by pneumonia, which is a weighty argument in favor of the vaccination of these patients from pneumococcal infection. The article presents generalized data on the use of 23-valent pneumococcal polysaccharide vaccine (PPV-23) in patients with IIRD who received inpatient and outpatient treatment at the V.A. Nasonova Research Institute of Rheumatology for the last 10 years. It has been shown that the vaccination of PPV-23 in patients with IIRD is characterized by high preventive efficacy (>90%), is safe and does not increase the risk of exacerbation of the disease. The sufficient immunogenicity of vaccination is evidenced by a significant increase in the levels of pneumococcal antibodies in the blood serum and the coefficient of post-vaccination response. The use of glucocorticoids (methylprednisolone, prednisolone) has no significant effect on the effectiveness, immunogenicity and safety of PPV-23 vaccination. The possibility of vaccination of PPV-23 with any activity of the process in patients with rheumatoid arthritis, systemic lupus erythematosus and spondyloarthritis (ankylosing spondylitis, psoriatic arthritis) with the condition of adequate therapy has been demonstrated. In order to develop clearer indications for vaccination, to determine time intervals for revaccination, to evaluate the effectiveness and safety of new pneumococcal vaccines, as well as to study the effect on the results of immunization of various anti-rheumatic drugs in patients with IIRD, further multicenter large-scale studies are needed.

Vaccination plays an important role in the prevention of infectious diseases in patients with immunoinflammatory diseases. When vaccinating patients with systemic lupus erythematosus (SLE), as with other immunoinflammatory rheumatic diseases, its safety is of great importance, including mitigating the risks of the primary disease or the development of new autoimmune phenomena. Many practitioners continue to consider autoimmune diseases as a contraindication for vaccination due to the perceived possibility of their exacerbation and reduced vaccine effectiveness during active immunosuppressive therapy.The lecture presents current data on the immunogenicity, efficacy and safety of vaccines against a number of infections caused by influenza viruses, hepatitis B, Herpes zoster, human papilloma viruses, COVID-19 and pneumococcus in patients with SLE. It has been shown that the benefits of vaccination in patients with SLE significantly outweigh the risk of adverse events or exacerbations of the disease. At the same time, it was noted that the problem of vaccination of such patients requires further study.

Background. Immunosuppressive drugs are widely used for the treatment of patients with spondyloarthritis (SpA) to effectively control the activity of the disease. At the same time, the use of these drugs is associated with an increased risk of developing infections of the upper and lower respiratory tract, which can be prevented by vaccination. The aim of the study was to evaluate the immunogenicity, safety, and clinical efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPV-23) in patients with SpA. Material and methods. The study included 54 patients with SpA: 39 with ankylosing spondylitis, and 15 with psoriatic arthritis. Most patients had a history of two or more cases of lower respiratory tract infections, 2 patients reported a monthly exacerbation of chronic sinusitis, one patient reported the development of otitis every 2–3 months. 72% of patients received immunosuppressive therapy at the time of inclusion in the study. PPV-23 was administered in the amount of 1 dose (0.5 ml) against the background of ongoing antirheumatic therapy. The level of antibodies to pneumococcal capsular polysaccharide was determined using the EIA PCP IgG kit (TestLine Clinical Diagnostics s.r.o., Czech Republic) at baseline, after 1, 3, and 12 months after vaccination. The tolerability of PPV-23, the effect of vaccination on SpA activity (according to the dynamics of the BASDAI index), and the incidence of upper and lower respiratory tract infections were assessed. Results. The concentration of antibodies to pneumococcal capsular polysaccharide was significantly higher 1, 3, and 12 months after vaccination compared to baseline. There was no negative effect of vaccination on the activity of SpA and the emergence of «new» autoimmune disorders. The vaccine was well tolerated by 76% of patients., Only one patient developed pneumonia during the observation period. Patients suffering from frequent sinusitis and otitis reported the absence of these infections after vaccination. Conclusions. Preliminary results of the study indicate sufficient immunogenicity, safety, and clinical efficacy of PPV-23 in patients with SpA.

Introduction. In modern reality postcovid syndrome (PCS) is characterized by clinical heterogeneity and multi-organ involvement, often presenting a differential diagnostic and therapeutic problem. However, in most studies of PCS, stratification of patients taking into account individual comorbid conditions was not performed. Thus, only an extremely small number of studies have been devoted to assessing the course of PCS in rheumatic diseasesPurpose. To characterize the features of the course of COVID-19 in patients with rheumatoid arthritis, as well as to conduct a comparative assessment of clinical and demographic parameters in groups of patients with rheumatoid arthritis, differentiated by the presence of PCS.Materials and methods. The material of the questionnaire which contained questions regarding socio-demographic data of respondents, information on rheumatological history, comorbid diseases, data on past COVID-19, including cases of re-infection, and PCS.Results.The study included 32 adult patients (29 women, 90%) with a reliable diagnosis of rheumatoid arthritis. Of the 32 patients who underwent COVID-19, in 23 cases it was possible to form a judgment about the presence or absence of PCS. To study PCS, 23 patients were stratified into two groups: 11 (47.8%) patients developed PCS (Group 1) and 12 patients had COVID-19 without consequences (Group 2). Both groups were represented predominantly by women (90.9% and 91.7%, respectively). In the general group 37.5% of patients with COVID-19 required inpatient treatment. The number of symptoms associated with COVID-19 did not correlate with RA activity, however, patients with higher RA activity were more likely to report increased arthralgia as a symptom of COVID-19. 47.8% of COVID-19 survivors experienced PCS. The average age, the number of comorbid diseases and the severity of RA symptoms at the time of COVID-19 were relatively higher in the group of patients with RA and PKS. Patients with PKS also noted a higher frequency of hospitalizations and a more severe course of COVID-19.Conclusions. A quantitative assessment of the risk of developing PKS is needed, which will serve as a basis for developing a strategy aimed at prevention, timely diagnosis and treatment of this syndrome in patients with RS. To this end, further studies on larger cohorts of patients are required.

Objective: to assess the safety of COVID-19 vaccines in patients with immunoinflammatory rheumatic diseases (IRD) in real clinical practice.Patients and methods. A cross-sectional study of patients with IRD, who were admitted to V.A. Nasonova Research Institute of Rheumatology for inpatient or outpatient treatment. All patients received at least 1 dose of vaccine against COVID-19 (main group). The control group consisted of vaccinated persons without IRD. All participants were interviewed by the researcher by filling out a unified questionnaire, additional information was obtained from medical records.Results and discussion. The study included 204 patients with IRD (151 of them were vaccinated with Sputnik V, 31 with Sputnik Light, 19 with СoviVac, 3 with EpiVacCorona; 173 patients received the second component of vaccine) and 131 subjects without IRD (101 of them were vaccinated with Sputnik V, 17 – CoviVak, 5 – Sputnik Light, 2 – EpiVacCorona, 6 – Pfizer/BioNTech; 124 patients received the second component of the vaccine). The number of patients with IRD who had both local and systemic reactions after administration of the first component of the vaccine was significantly less than in the control group (19.6 and 38.9%, respectively; p

Lyme disease (LD) or tick-borne borreliosis affects thousands of people every year in different regions of the world, primarily in the United States and Europe. Given the great social and medical importance of this problem, an updated version of the clinical guidelines for the prevention, diagnosis and treatment of PD was published in November 2020 by a committee of experts of the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN) and the American College of Rheumatology (ACR). This article discusses the main issues of the use of antibacterial drugs in LD. The most commonly used medications are doxycycline, amoxicillin, cefuroxime axetil, and ceftriaxone. Patients with erythema migrans receive appropriate antibiotics for 7–14 days, depending on the medication used. In case of other clinical manifestations of LD, the duration of treatment is extended to 14–28 days. Antibiotic prophylaxis is carried out using a single oral dose of 200 mg doxycycline for adults and 4.4 mg/kg (with a maximum of 200 mg) for children. This treatment scheme is highly efficient, easy to administer, and has a relatively low risk of adverse events.

The experimental results of the extremely low frequency emission characteristics excited in the outer ionosphere under the ionospheric plasma heating by high-latitude EISCAT facility are presented. The experiments have been conducted in the period of 2006–2010 yr. using two main schemes of extremely low frequency generation including the impact of the heating facility amplitude modulated emission and two unmodulated pump waves with the frequency detuning. In-situ measurements of the plasma wave disturbances were performed at the outer ionosphere heights using on-board equipment of DEMETER microsatellite. In work the spatial, amplitude and spectral characteristics of the generated extremely low frequency emissions are determined. It is shown that the characteristic size of the extremely low frequency emission is about 400–600 km along the trajectory of the DEMETER microsatellite. The registration area spatial position is determined by both the applied generation scheme and the background plasma density distribution. The extremely low frequency emission electric field strength at the Earth’s outer ionosphere heights is 50–330 μV/m.

The review analyzes data on the course and outcomes of axial spondyloarthritis (axSpA) accumulated over the previous 2.5 years of the COVID-19 pandemic. The issues of clinical and immunological efficacy of vaccination against COVID-19 in this disease are considered. It was noted that the presence of axSpA, as well as treatment with tumor necrosis factor-á inhibitors and non-steroidal anti-inflammatory drugs, did not significantly increase the risk of COVID-19 infection and did not worsen its outcomes, apart from an increase in the incidence of venous thromboembolism. At the same time, it is assumed that anticytokine therapy for SpA may protect against severe COVID-19 course.The data presented suggest that the benefits of vaccination in SpA far outweigh the potential harms associated with the development of adverse events. It has been shown that in patients with SpA, vaccination does not affect the activity of the inflammatory process, and biologic disease modifying antirheumatic drugs have almost no significant effect on the post-vaccination response.

According to experts, the human immunodeficiency virus (HIV) epidemic has a steady downward trend, but the attention of the medical community to this problem is not waning. Before the introduction of highly active antiretroviral therapy, the prevalence of rheumatic manifestations in HIV-infected patients ranged from 3 to 71% and was associated with late stages of infection and severe immunosuppression. HIV-associated arthritis, reactive arthritis, psoriatic arthritis, arthralgias and diffuse infiltrative lymphocytosis syndrome are the most common rheumatic pathologies in HIV. Most people with HIV and musculoskeletal inflammatory disease respond well to NSAIDs, opioids, and basic anti-inflammatory drugs. In cases that are torpid to the abovementioned treatment, the use of biologic disease-modifying antirheumatic drugs may be required.The lecture summarizes modern data on the features of the course and treatment of immunoinflammatory rheumatic diseases in HIV infection.

The problem of comorbid infections in rheumatology seems to be very relevant in connection with the active introduction into clinical practice of innovative disease-modifying anti-rheumatic drugs (DMARDs), the so-called targeted DMARDs (tDMARDs), as well as genetically engineered biological drugs (biologics), the action of which is directed at specific links in the pathogenesis of immuno-inflammatory rheumatic diseases. With the accumulation of global clinical experience, the association of the use of these drugs with an increasing risk of developing comorbid infections of various nature and localization has become clearly traced. The real way out of this situation seems to be the creation, improvement and introduction into clinical practice of various vaccines. At the same time, a number of anti-rheumatic drugs may have a certain negative effect on the immunogenicity of some vaccines, which may lead to a decrease in the preventive effectiveness of the latter. This review presents the latest data on the effect of various anti-rheumatic drugs on the immunogenicity of vaccines against influenza, pneumococcal and herpes virus infections, viral hepatitis B, yellow fever and COVID-19 used in rheumatological patients. It has been shown that the anti-B-cell drug ritux imab has a significant negative effect on the immunogenicity of vaccines, which increases with a shortening of the time between immunization and the use of the drug. Methotrexate also negatively affects the immunogenicity of most vaccines, but to a lesser extent. Abatacept probably reduces the immunogenicity of vaccines, although studies were performed in the absence of adequate control groups. Tumor necrosis factor inhibitors-α and tDMARDs (janus kinase inhibitors) reduce the absolute values of antibody concentrations for many vaccines, but apparently do not have a significant effect on the frequency of patients who have achieved seroprotection. Inhibitors of interleukin (IL) -6, IL-12 / IL-23 and IL-17 practically do not affect the immunogenicity of vaccines. The accumulated data on the effect of the above drugs on the immunogenicity of the vaccine against SARS-CoV-2, apparently, are similar to those obtained in studies on vaccination against other infections in patients with immuno-inflammatory rheu matic diseases. Further clinical studies are needed to assess the effect of immunosuppressive therapy on the vaccine response and to develop methods for its optimization.

The materials of the Russian NIIR/ARP-COVID-19 database, which included adult (over 18 years old) patients with immuno-inflammatory rheumatic diseases (IIRD) who underwent COVID-19 (coronavirus disease 2019), and a literature review concerning the course and outcomes of COVID-19 in patients with these diseases, are presented. From July 17, 2020 to April 23, 2021, 156 messages were received and analyzed. The study group was represented mainly by women (75%). The average age of patients was 52.0±14.8 years, of which 53 (33.9%) patients were aged 60 years and older. The most frequent clinical manifestations of COVID-19 were fever (62.2%), cough (40.4%), anosmia (37.8%), shortness of breath (33.3%). During the course of COVID-19, computed tomography of the chest organs was performed in 143 patients. When assessed on an “empirical” visual scale, stage 0 of lung lesion was observed in 49 (34.3%) patients, stage 1 in 40 (28%), stage 2 in 35 (24.5%), stage 3 in 19 (13.2%), stage 4 in 0. In the study group, a favorable outcome was observed in 137 (97.9%) patients. Fatal outcome was registered in 3 patients. The effect of COVID-19 on the course of IIRD was assessed in 131 patients: in 52 (39.7%) patients, the course of IIRD worsened, in 1 (0.8%) it improved, in 78 (59.5%) there was no effect. Literature data on the risk of infection with the SARS-CoV-2 virus, the course and outcomes of COVID-19 in rheumatic and musculoskeletal diseases are contradictory, which dictates the need to continue collecting data on the rheumatological problems of COVID-19 in the Russian patient population, taking into account international experience.

Currently, the close attention of the medical and international community is still riveted on the novel coronavirus infection, which caused the pandemic in 2020. Understanding the underlying mechanisms of coronavirus disease-2019 (COVID-19) made it possible to move from the empirical selection of therapy, which was observed at the beginning of the pandemic, to the pathogenetically justified prescription of drugs, including glucocorticoids, anticoagulants, as well as some antirheumatic drugs. However, despite the huge amount of scientific and clinical material accumulated over 1.5 years, the interest in this problem does not wane both due to the existence of a number of unresolved issues, and due to the constant emergence of new (often contradictory) data.