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The problem of comorbidity is widely discussed in modern medical literature. Its role in rheumatic diseases is of particular interest due to their multifactorial nature and the involvement of a wide range of pathogenetic mechanisms. For many years, researchers around the world have noted correlations between the presence of active autoimmune disorders and the complicated course of cardiovascular diseases. A deeper understanding of the pathogenetic mechanisms at the present stage of development of rheumatology allows us to take a fresh look at the relationship between atherosclerosis and rheumatoid arthritis. The definition of multimorbidity developed in recent years and the results of recent scientific studies may contribute to a more correct choice of tactics for managing patients with a combination of these two diseases.

Objective: to evaluate the effectiveness of therapy with AMBENE®Bio (AB) in comparison with the comparator drug (bioactive concentrate of small marine fish, BCSMF) in patients with osteoarthritis (OA) of large and small joints in routine clinical practice.Patients and methods. KOLIBRI multicenter, observational, non-randomized, comparative study included 233 patients with OA of the small hand joints (HJ) or knee joints (KJ) from three Russian centers (two in Moscow and one in Tula). Patients with a generalized form of OA were excluded from the analysis. The remaining patients were divided into two groups depending on the localization of OA. The first group included 174 patients with knee OA, 105 of them received AB, and 69 received the reference drug (BCSMF) according to the same regimen. The second group consisted of 21 women with HJ OA: 13 patients were prescribed AB, and 8 — the reference drug.The duration of the study averaged 330±14 days, the total number of visits was 4. The main indicator of effectiveness was the dynamics of pain during movement according to VAS (0—100 mm) 30±7 days after the start of treatment compared with the baseline value. All patients underwent radiography of the HJ and KJ, as well as ultrasound of the involved joints.Results and discussion. Both drugs provided significant clinical improvement in patients with OA, which is consistent with other studies with similar design and long follow-up. These data confirm the symptom-modifying properties of the presented group of combined drugs in the OA treatment. The Russian injectable drug AB in OA was not inferior in effectiveness to the foreign BCSMF. According to the OMERACT-OARSI criteria, 85.2% and 88.9% of patients, respectively, responded to treatment with AB and the reference drug. In both groups, half of the patients managed to stop further use of non-steroidal anti-inflammatory drugs (NSAIDs) on a regular basis.Conclusion. The use of AB was accompanied not only by a decrease in the severity of clinical symptoms of OA, but also by a decrease in the daily requirement for NSAIDs almost by 2 times.

One of the main tasks of modern complex therapy of rheumatoid arthritis (RA) is to improve the quality of life of patients. To do this, it is necessary not only to achieve remission or low activity, but also to successfully control the main, most painful, manifestations of the disease. Therefore, when evaluating the results of RA treatment, the dynamics of not only standard indices (DAS28 (Disease Activity Score 28), CDAI (Clinical Disease Activity Index), SDAI (Simplified Disease Activity Index)), but also the so-called “patient reported outcomes” (PRO) – a patient’s global assessment of disease activity (PGA), pain, functional disorders and fatigue.This review examines the effect of one of the main classes of anti–rheumatic drugs - biological disease-modifying antirheumatic drugs (bDMARDs) on the PROs. The results of a series of randomized controlled trials are presented, in which changes in PROs were studied using various tumor necrosis factor α (TNF-α) inhibitors, abatacept T-lymphocyte co-stimulation inhibitor, rituximab CD20 inhibitor and interleukin (IL) 6 inhibitors.The use of bDMARDs in combination with methotrexate (MTX) provides a reduction in PGA and pain by 50-60%, functional disorders according to HAQ (Health Assessment Questionnaire) and fatigue according to FACIT-F (Functional Assessment of Chronic Illness Therapy – Fatigue) – by 15-30%. B DMARDs monotherapy (with the exception of the effect of tocilizumab on HAQ) does not exceed MTX monotherapy in its effect on PROs. Monotherapy with tocilizumab provides more favorable dynamics of PGA and pain than monotherapy with TNF-α inhibitors. An important advantage of IL-6 inhibitors is the rapid achievement of a clinical effect, which is noted already in the first 2 weeks after the first administration of the drug.

The need for effective drugs for the treatment of knee osteoarthritis (OA) is constantly growing. Current guidelines recommend the use of symptomatic slow acting drugs for osteoarthritis (SYSADOA) such as glucosamine (GCA) in this disease. Among various drugs containing GCA, high bioavailability and clinical efficacy have been shown only for prescription crystalline GCA sulfate (pGCAS) administration. Several meta-analyses and network meta-analyses have shown that efficacy of pGCAS 1500 mg once daily is superior to other GCA-based products (such as GCA hydrochloride with or without sodium sulfate) and the combination of GCA with chondroitin sulfate (CS) in terms of reducing the intensity of pain and improving the functional state. These studies confirmed the favorable safety profile of pGCAS, which was comparable to placebo in the incidence of adverse events. Pharmacoeconomic studies have also demonstrated greater cost-effectiveness of pGCAS compared to other GCA drugs.A group of Russian experts at a meeting of the advisory committee reviewed the evidence in favor of the use of pGCAS and evidence of its effectiveness in the treatment of knee OA in comparison with other products that include GCA, and the fixed combination of GCA with CS. Taking into account the results obtained, the use of pGCAS at a dose of 1500 mg once a day is recommended as a rational choice for the treatment of knee OA.

The prescribing of biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (iJAK) during the COVID-19 pandemic requires a balanced approach and tight monitoring of the patients.The aim of the study was to study the effect of bDMARDs and iJAK inhibitors on the condition of patients with rheumatoid arthritis (RA), taking the patients reported outcomes, as well as the incidence of COVID-19 in these patients.Materials and methods. A telephone survey was conducted of 254 patients with RA (average age – 49.8±13.7 years; 64.4% of patients are positive for rheumatoid factor; women – 83.5%; DAS28 score – 5.4±1.6 points), who in the period from January 2020 to June 2021 were prescribed bDMARDs or iJAK for the first time: 148 (58.3%) – rituximab; 57 (22.4%) – tumor necrosis factor α inhibitors; 20 (7.9%) – iJAK; 17 (6.7%) – interleukin 6 inhibitors; 12 (4.7%) – abatacept.Results. At the time of the survey, 204 (80.3%) patients continued taking prescribed medications. The main reason for the interruption of treatment was administrative problems. Synthetic DMARDs (mainly methotrexate and leflunomide) were received by 68.0%, glucocorticoids – 45.3%, nonsteroidal anti-inflammatory drugs – 44.5% of respondents. Among patients treated with bDMARDs or iJAK, 68.1% noted «the state of symptoms acceptable to the patient», the absence of frequent joint pain – 65.3%, the absence of increased fatigue – 14.3%. The incidence of COVID-19 and hospitalization associated with this disease did not differ in individuals who continued and stopped using bDMARDs or iJAK: 41.2% and 44.6%, 13.7% and 14.0%, respectively (p=0.80884). There were no statistically significant differences in the incidence of COVID-19 and hospitalization associated with this disease in patients taking various bDMARDs or iJAK.Conclusion. Despite the COVID-19 pandemic, rituximab remains one of the most popular bDMARDs. About a third of patients receiving bDMARDs or iJAK are not satisfied with their condition. More than 40% of patients who received these drugs suffered COVID-19; 14.0% required hospitalization.

Objective: to compare the course of the disease and therapy in rheumatoid arthritis (RA) patients who meet and do not meet the criteria for difficult- to-treat RA (D2T).Patients and methods. The study included RA patients who met the 2010 ACR/EULAR criteria and who were hospitalized in the V.A. Nasonova Research Institute of Rheumatology from March to October 2021. All patients underwent a conventional clinical and laboratory examination, radiography of the hands and distal feet, and the radiological stage of RA according to Steinbroker was assessed. To determine the inflammatory activity, the DAS28-ESR and DAS28-CRP indices were calculated.Results and discussion. The study included 303 patients with RA, 25 (8.4%) of them had D2T RA. The duration of RA in the D2T group was significantly longer than in other patients (15.9±11.8 and 11.9±9 years, respectively; p=0.04). X-ray changes in the joints in D2T were more pronounced. Patients with D2T had higher inflammatory activity at the time of hospitalization than patients who had continued prior therapy with biologic/targeted synthetic DMARDs. The dose of glucocorticoids (GC) in patients with D2T RA was higher compared to patients of other groups: on average 8.3±5.1 and 6.4±2.9 mg/day, respectively (p=0.02).Conclusion. The results of this study suggest that in Russia, as well as abroad, the treat-to-target principle has not yet become widespread, and the selection of adequate therapy takes too much time. At the same time, Russian rheumatologists primarily use GC to suppress inflammatory activity. The introduction of modern recommendations for the management of patients with RA into routine clinical practice, could possibly restrain the formation of D2T RA.

Objective: to assess the quality of life (QoL) using general and special questionnaires and to identify the relationship between fatigue and sarcopenia (SP) in elderly and senile people.Patients and methods. The cohort study included 230 patients, including 177 women (77%) and 53 men (23%) over 65 years old (median age 75 [68; 79] years). The presence of SP was determined according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2, 2018). QoL was studied using the general questionnaires EQ-5D, SF-36 and a special questionnaire SarQoL, the level of fatigue – using the FACIT-F questionnaire. To assess the possibility of using the FACIT-F scale for SP screening, its sensitivity, specificity, diagnostic accuracy, positive and negative predictive value were determined, a receiver operating characteristic (ROC) curve (ROC analysis) was constructed, and the area under the ROC curve (AUC) was calculated.Results and discussion. The assessment of QoL using the EQ-5D and SF-36 questionnaires did not reveal significant differences between the groups of patients with and without SP (p>0.05). When analyzing the state of health in the study cohort using the special SarQoL questionnaire, the overall indicator was 63.12±18.83 points, while in patients with SP it was significantly lower than in patients without SP (50.65±14.23 and 75,10±14.46 points, respectively; pThe level of fatigue on the FACIT-F scale ranged from 10 to 52 points and averaged 32.5 [29.1; 35.3] points, while in patients with SP the overall score was lower than in elderly people without SP (25.1 [22.13; 29.23] and 39.8 [36.4; 42.4] points respectively; p10 mg/L (pThe possibility of using the FACIT-F questionnaire for screening patients with SP was evaluated. Its sensitivity reached 76%, specificity – 73%, positive predictive value – 53%, and negative predictive value – 88%, diagnostic accuracy – 74%. The area under the ROC-curve (AUC) was 0.726 (95% CI 0.627–0.826; pConclusion. It has been shown that the general questionnaires EQ-5D and SF-36 do not reflect the true QoL impairment in SP. A significant deterioration in the state of health in elderly people with SP can be identified by a special SarQol questionnaire. The FACIT-F fatigue scale can also be used to screening in SP.

The widespread introduction into clinical practice of modern approaches to the treatment of rheumatoid arthritis (RA), the rational use of traditional and targeted antirheumatic drugs can effectively suppress inflammatory activity, restrain the progression of the disease and improve the quality of life of patients. At the same time, in some patients, even after the repeated change of targeted drugs, it is not possible to achieve the target level of RA activity. Serious difficulties arising in the management of such patients raised the question of identifying a special variant of the disease – difficult-to-treat (D2T) RA. The presence of various variants of D2T RA and the need to use a personalized approach to therapy justify the creation of special recommendations for the management of this category of patients. The first step in preparing these recommendations was the definition of D2T RA recently presented by the EULAR working group. It includes three criteria: 1) insufficient effectiveness of the therapy; 2) the presence of an active symptomatic disease; 3) clinical perception.

Objectives: evaluation of the clinical efficacy and safety of the healthy joints maintaining compound Artroflex®in knee osteoarthritis (OA) in postmenopausal overweight women in outpatient clinical practice.Patients and methods. An open, prospective observational single-center post-marketing study included 30 postmenopausal women 50–75 years old (mean age 62.3±6.3 years) with knee OA. Patient body mass index (BMI) was >25 (mean body weight 85.3±15.3 kg). Radiographically confirmed primary gonarthrosis stage II according to Kellgren–Lawrence was detected in 26 (87.0%) patients, stage III – in 4 (13.0%). The duration of knee OA ranged from 1 to 21 years (average 7.8±6.1 years).Artroflex®was prescribed 1 capsule 2 times a day for 3 months. During three visits (baseline, after 1 and 3 months), the need for analgesics or non-steroidal anti-inflammatory drugs (NSAIDs) and the occurrence of adverse reactions (AR) were determined. Health status and pain level were also assessed using a visual analogue scale (VAS), the severity of pain and stiffness, limited function according to the WOMAC questionnaire, fatigue/fatigue according to the FACIT scale, the Charlson comorbidity index, satisfaction of the doctor with the results of treatment using the IMOS scale, and satisfaction of the patient with using the IMPSS scale.Results and discussion. A statistically significant decrease in the pain score according to the VAS, an improvement in health status, and the WOMAC index were found in the overwhelming number of patients, regardless of BMI. 90% of women noted decrease in fatigue/fatigue on the FACIT scale, and 93% of patients reported satisfaction with treatment, regardless of the Charlson comorbidity index. The need for NSAIDs after one month of use of the Artroflex®compound decreased by 7%, after 3 months – by 23%. A negative feedback was found between the baseline indicator of health status and the assessment of the effectiveness of therapy. No serious ARs were identified during the study.Conclusion. Feasibility of using the Artroflex®compound in real clinical practice in patients with knee OA and excessive body mass has been shown.

Levilimab (LVL) is a monoclonal antibody against the interleukin-6 receptor (IL6R). The article presents data obtained during 56 weeks of the AURORA phase II study.Objective: to evaluate the efficacy safety and immunogenicity of LVL in methotrexate (MTX) resistant patients with active rheumatoid arthritis (RA).Materials and methods. 105 patients with active RA were randomized in a 1:1:1 ratio into two LVL or placebo groups. LVL was administered subcutaneously at a dose of 162 mg every week (QW) or every other week (Q2W). All patients received MTX. After evaluating the primary endpoint of 20% improvement in ACR criteria (ACR20) at week 12, patients in the placebo group were switched to LVL Q2W. The study duration was 56 weeks. The frequency, profile, degree and severity of adverse events were determined in each group for safety assessment. The immunogenicity of LVL was determined by the proportion of patients with identified binding and neutralizing antidrug antibodies. Results. LVL in both regimens was superior to placebo. At week 12, the incidence of ACR20 achievement was 77.1% (LVL QW), 57.1% (LVL Q2W), and 17.1% (placebo) with 95% confidence intervals [37.53; 82.54] (pConclusion. In MTX-resistant patients with active RA, the efficacy of both LVL regimens at a dose of 162 mg in combination with MTX was significantly superior to MT monotherapy. LVL QW lead to highest treatment response. LVL has been shown to be well tolerated and low immunogenicity. LVL safety profile is similar to IL6R inhibitors.

The paper gives the current definition of osteoarthritis (OA), which reflects the pathogenetic and clinical characteristics of this disease, as well as general principles for choosing an OA treatment. It describes the effect of glucosamine and chondroitin on the key pathogenetic mechanisms of OA. It is noted that one of the promising areas of therapy for OA is the intra-articular administration of biopolymer-based hydrogels that provide not only an anti-inflammatory, but also regenerative effect that has been experimentally confirmed during their injection into the tendon sheaths. There are data on the efficacy and safety of the Russian drug Sphero®gel, a biopolymer-based microheterogeneous collagen-containing hydrogel that belongs to a class of multicomponent biopolymer-based extracellular matrix mimetics. It consists of the cross-linked farm animal tissue-derived collagen microparticles placed in the gel base. The gel is not only a structural base for collagen microparticles; it also has its own therapeutic potential, since it is structurally similar to the natural extracellular matrix. The drug contains collagen, biologically active components of the extracellular matrix, such as proteoglycans, glycoproteins, uronic acids, growth factors, monosaccharides, and chondroitin sulfate. Extended-release symptomatic agents, Sphero®gel among them, are currently recommended for the treatment of OA. Application of Sphero®gel contributes to increased joint mobility and reduced pain, which allows the limited use of nonsteroidal anti-inflammatory drugs that cause adverse reactions, especially in the presence of comorbid diseases.

The prevalence of sarcopenia in different countries of the world has been well studied. However, the criteria of different international professional groups are used to diagnose the disease, which leads to large variability in data on the frequency of sarcopenia in the population. The paper presents the results of studying the frequency of sarcopenia, by using the diagnostic criteria of different working groups. The measures characterizing muscle strength and skeletal muscle function were analyzed; the components that are most important for the diagnosis of sarcopenia were identified in the studied patient group. Objective: to determine the detection rates of sarcopenia among people aged over 65 years in accordance with the guidelines of different international professional groups and to identify the most significant component for its diagnosis. Subjects and methods. The investigation enrolled 230 people older than 65 years (mean age, 74.0±6.5 years) who were followed up in an outpatient setting. Sarcopenia was diagnosed according to the 2010 European Working Group on Sarcopenia in Older People (EWGSOP) criteria. To confirm its diagnosis, the appendicular muscle mass index (AMMI) was calculated using dual-energy X-ray absorptiometry (DXA) on a HOLOGIC QDR Explorer; muscle strength was measured with a Jamar-J00105 handheld dynamometer (Sammons Preston Inc., USA). Muscle function was also examined using the short physical performance battery (SPPB). The frequency of sarcopenia diagnosed by the criteria of the International Working Group on Sarcopenia (IWGS), the Foundation for the National Institutes of Health (FNIH), and EWGSOP were comparatively analyzed. Results and discussion. The frequency of sarcopenia in the sample of people aged over 65 years was the same when using the diagnostic EWGSOP and IWGS criteria (30%) and was significantly higher than when applying the FNIN criteria (19.8%). The frequency of sarcopenia increased from 21.4% at the age of 65–74 years to 52.9% at the age of over 85 years according to the EWGSOP and IWGS criteria and from 16.2% to 29.4%, respectively, by the FNIN criteria. Dynamometry showed that the muscle strength was significantly lower in patients with low muscle mass than in those with normal muscle mass (the average mass was 15.1±5.4 and 18.2±5.4 kg, respectively; p

These clinical guidelines have been developed under the auspices of the All-Russian public organization «The Association of Rheumatologists of Russia» and the public organization «Russian Osteoporosis Association» and are dedicated to the diagnosis of the risk of falls and their prevention in elderly people who have a high frequency of falls and their serious consequences as injuries varying in severity, as fractures, developed pain, a loss of ability to perform everyday activities and to take care of themselves. The paper presents risk factors for falls and risk assessment methods and formulates main provisions for preventing falls in older people, by taking into account their place of stay: at home, hospital or social services facilities.

Pathological changes of large joints (knee, hip) in osteoarthritis (OA) are accompanied by the development of muscle weakness, decreased proprioception and imbalance.Objective: assessment of skeletal muscles state in women over 65 years old with OA of large joints and determination of the main factors affecting the risk of sarcopenia.Subjects and methods. In 159 women with OA (mean age 74±6 years), muscle mass was assessed with the appendicular lean mass index (ALM) using dual-energy X-ray absorptiometry (DXA). Muscle strength was measured by hand dynamometer, muscle function was determined by the results of a brief set of physical activity tests (short physical performance battery – SPP). The quality of life was analyzed by the EQ-5D questionnaire, pain assessment was carried out using a visual analog scale (VAS).Results and discussion. Patients with sarcopenia were significantly more likely to have lower rates of ALM index (p

In recent years, the long-term survival of patients with systemic lupus erythematosus (SLE) has increased to more than 90%, but there are still quite a few unresolved problems. Although the main objective of the concept of «Treatment of SLE to target» is «remission of symptoms and absence of organ damage», it was recognized that there is currently no generally accepted definition of remission in SLE. The article discusses different variants of the definition of «remission» in SLE.

The aim is to carry out language adaptation and validation on the Russian sample of a special SarQoL questionnaire, designed to assess the quality of life of elderly people with sarcopenia. Material and methods. 100 patients over 65 years, mean age 74.0±6.5 years, observed on an outpatient basis were included. 50 from them had sarcopenia and 50 participants were without it. The diagnosis of sarcopenia was based on criteria developed by the European working group on sarcopenia (EWGSOP, 2010). The validation procedure was carried out in accordance with the Protocol. Results and discussion. There was a significant decrease in the overall quality of life according to SarQoL questionnaire in patients with sarcopenia compared with the control group without sarcopenia (50.65±14.23 and 75.10±14.46, respectively; pConclusion. The Russian version of the SarQoL questionnaire is valid, consistent and reliable and can be used to assess the quality of life in older patients with sarcopenia.

Objective: to identify irreversible organ damages and factors influencing their development and to compare existing musculoskeletal injuries with the activity of systemic lupus erythematosus (SLE).Patients and methods. The investigation enrolled 197 peri- and postmenopausal female outpatients (mean age, 50.94±9.1 years) with SLE, who were followed up at Clinical Rheumatology Hospital Twenty-Five, Saint Petersburg. The mean disease duration was 9.7±7.5 years. Cytostatic and glucocorticoid (GC) treatment regimens and dosages in the examinees were analyzed on the basis of their primary medical records. The investigators assessed the current disease activity by the SLE Disease Activity Index (SLEDAI-2K) and the Lupus Low Disease Activity State (LLDAS) and irreversible organ damages by the Systemic Lupus International Collaborating Clinics (SLICC) Damage Index (DI).Results and discussion. 93.4% of the patients continued to receive GS therapy at the time of inclusion in the study. The median GS maintenance dose was 12.5 mg/day. Almost half of the patients (n=86/43.7%) were in menopause (its mean duration was 12.8±7.1 years). Half of the examinees were noted to have remission (n=36/18.3%) or low SLE activity (n=92/46.7%) according to the SLEDAI-2K. Fifty-seven (28.9%) patients met all 5 LLDAS criteria; at the same time other 96 (48.7%) patients met 4 out of the 5 criteria, the 5th criterion being a high GC maintenance dose. High DI scores of ≥4 were found in two thirds (n=131/66.5%) of the examinees. Musculoskeletal system injuries ranked first among other disorders: osteoporosis (OP) and muscle weakness were detected in 76 (38.6%) and 69 (35.0%) patients, respectively. Regression analysis involving all statistically significant factors showed that the degree of damage was influenced by age (p=0.013215), total GS dose (p=0.000047), and previous therapy with cyclophosphamide (p=0.041505).Conclusion. The contribution of GS therapy to irreversible damage accrual is obvious in peri- and postmenopausal women with SLE. Timely dose adjustment or complete withdrawal of GS during remission in SLE is one of the key factors that substantially reduce the risk of progression of irreversible organ damages due to the prevention of OP and osteoporotic fractures in these patients.

Objective : to analyze the dynamics of quality of life (QOL) in patients with prior osteoporotic vertebral compression fracture during an 18-month follow-up study. Subjects and methods . The investigation enrolled 219 patients (mean age, 67.6 years) with vertebral fracture from seven centers of the Russian Federation. QOL was assessed four times using the EQ-5D (EuroQoL-5D) and TTO (Time Trade-Off) questionnaires during an 18-month prospective follow-up study. The work was done within the framework of the International Multicenter Study ICUROS (The International Costs and Utilities Related to Osteoporotic Fractures Study) organized by the International Osteoporosis Foundation (www.icuros.org). Results and discussion . The patients with vertebral compression fracture showed a statistically significant decrease in QOL throughout the follow-up period. Immediately after the fracture, there was a dramatic decrease in the total EQ-5D score, followed by its gradual increase. However, the emerging trend in QOL recovery proved to be unstable, and by the end of the 18th month, it was significantly lower than that before the fracture. On the contrary, the TTO questionnaire showed that QOL drastically decreased immediately after fracture, but at month 4 it reached the level that was before the fracture, and remained stable until the end of the follow-up period. Conclusion . The performed investigation enabled us to obtain data on QOL using the EQ-5D (QOL assessment from the social point of view) and TTO (individual QOL assessment) in the population of residents of the Russian Federation, in men and women aged 50 years and older with osteoporotic vertebral compression fracture.

The investigators carried out an analysis of the efficacy and safety of secukinumab (SEC) in the randomized placebocontrolled trials (RPCTs) FUTURE 1 and FUTURE 2, as well as a subanalysis of the data obtained in the Russian population of patients with active psoriatic arthritis (PsA). The FUTURE 1 and FUTURE 2 trials enrolled a total of 1003 patients with active PsA. They received SEC (n = 703) or placebo (PL) (n = 300). The use of SEC 300 or 150 mg without previous intravenous (IV) loading dose or either 150 or 75 mg with the IV loading dose led to a significant improvement in patients with PsA. The positive changes in the main clinical manifestations of PsA at 24 weeks persisted until 52 weeks of therapy. SEC was effective in both the patients who had not previously received tumor necrosis factor-α inhibitors and those who had previously taken these drugs, and the result of therapy did not depend on concomitant methotrexate use.The incidence of cancer was low and comparable in the SEC and PL groups. Analysis of the combined data on the safety of the two RPCTs showed that the treatment duration-adjusted incidence of malignant neoplasms was 0.5 per 100 patient-years in the SEC groups and 0.9 in the PL groups. The safety profile of SEC in these RPCTs corresponds to that in the previous studies of the drug.The data from the pooled analysis of the Russian subpopulation of patients with PsA fully agree with the results obtained in the evaluation of all the patients included in FUTURE 1 and FUTURE 2 and confirm the most important role of IL-17А in the pathogenesis of PsA.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that most commonly occurs in women. Improved treatments for SLE have led to a substantial increase in the life expectancy of patients, so the problems of complications of both the disease itself and its therapy have come to be top priority. The most common complications of SLE among the musculoskeletal system lesions are osteoporosis and related vertebral compression fractures (VCFs). However, only one third of these fractures has clinical manifestations and causes the patient to seek medical advice. More VCFs remain undetected because they have no or scarce symptoms. The question of the influence of various factors (gender, age, menopause, etc.) on the incidence of VCFs in patients with SLE remains open. It should be expected that in postmenopausal women with SLE, the incidence of VCFs may be considerably higher than that in the population.Objective: to determine the frequency of and to evaluate the role of various factors in the development of asymptomatic vertebral fractures in postmenopausal women with SLE (a retrospective study).Subjects and methods. A total of 86 postmenopausal women (mean age, 59±7.9 years) with a diagnosis of SLE, which met the 2012 Systemic Lupus Collaborating Clinics (SLICC) criteria, were examined. The mean duration of the disease and menopause was 15±8.3 and 12.8±7 years, respectively. All the patients with SLE were treated with glucocorticoids (GC) at a dose of 15±5 mg/day calculated with reference to prednisolone for more than 12 months (mean, 159.7±90.9 months) and had a low disease activity (the mean SLEDAI-2K score was 5.1±3.9). The ACR damage index for SLE averaged 5.5±2.6. All the patients underwent vertebral fracture assessment (VFA) using a Hologic Explorer bone densitometer to identify VCFs in the thoracic and lumbar spine. The anterior, middle, and posterior heights of ТhIV–LV, and the height of each vertebra as well as the underlying vertebra were calculated and compared. If the differences in the anterior, middle, or posterior vertebral heights were >20–25%, this deformation was regarded as VCFs. Bone mineral density (BMD) in the hip and spine was measured with an X-ray bone densitometer. Results. VFA revealed VCFs in 40 (46.5%) patients with SLE; these were detected for the first time in 22 (55%) patients since they had no significant clinical manifestations. VCFs happened most commonly in the mid-thoracic spine (ThVI–IX). All the patients with asymptomatic VCFs had a fracture of only one vertebra. The patients with VCFs had a longer duration of SLE and menopause, more frequently received cytostatic therapy, and had a higher cumulative dose and a longer duration of GC therapy. They also had a higher damage index and lower BMD values in LI–IV than patients without VCFs (p < 0.05). Neither SLE activity nor hip BMD was associated with VCFs (p > 0.05).Conclusion. The detection rate for VCFs is nearly 50% in postmenopausal women with SLE, and about every two VCFs remain undetected. The long duration of SLE, menopause, and GC treatment, a high cumulative dose, a high damage index and low BMD values in LI–IV were associated with VCFs. VFA is an effective screening method to detect asymptomatic VCFs.

Postmenopausal osteoporosis is a progressive systemic disease of the skeleton, characterized by a decrease in bone mass and a violation of the architectonics of bones, accompanied by an increased tendency to fractures. Osteoporosis is an important medical and social problem due to its high prevalence and frequent complications - skeleton bone fractures, which lead to temporary and permanent disability, worsen the quality of life, and increase mortality, especially among the elderly. According to various authors, mortality rates during the 1st year after a femoral neck fracture range from 12 to 40%. In half of the patients who survived after the fracture, the ability to self-care is significantly limited or lost.Постменопаузальный остеопороз — это прогрессирующее системное заболевание скелета, характеризующееся снижением костной массы и нарушением архитектоники кости, сопровождающееся повышенной склонностью к переломам. Остеопороз является важной медицинской и социальной проблемой в связи с его высокой распространенностью и частыми осложнениями — переломами костей скелета, которые приводят к временной и стойкой утрате трудоспособности, ухудшают качество жизни, повышают смертность, особенно среди лиц пожилого и старческого возраста. По данным различных авторов, показатели смертности в течение 1-го года после перелома шейки бедра составляют от 12 до 40%. У половины больных, выживших после перелома, существенно ограничивается или утрачивается способность к самообслуживанию.

The purpose of our study was to evaluate the parameters of the stabilogram in people over 65 years of age and to identify the parameters of the stabilometric study, which had statistically significant connections with falls and fractures.The study included 308 patients older than 65 years, living in their own homes. To perform the research tests with open (OG) and eyes closed (MO). It uses the European approach positioning stop on the platform: the patient is installed in the position of the foot heels together, toes apart. Patients during the testing behavior did not use orthopedic vehicles as walkers, walking sticks.The study found gender differences in the speed V (p0,01) and area S (p0,01), the center of pressure stop (CD) on at Stabiloplatform conducting tests with open and closed eyes. At the age of 85 years found significant deviations of speed (V) CD stabilogram in open and closed eyes tests (p0,01), corresponding to a high frequency of falls 61,36% (95% CI 45,5-75,6; p0,05). In patients with rare (other) fractures, there were deviations in the mean direction of the oscillations during a sample with open eyes  (OG) (p0,05). There were no statistically significant differences in the stabilometric parameters in the presence of hip fractures and vertebral fractures (p0,05). Thus, the stabilometry method can be used in elderly people for early detection of imbalance and the risk of developing falls that will prevent the development of fractures.Цель исследования — выявление параметров стабилограммы у людей старше 65 лет, имеющих корреляцию с падениями и переломами. В исследовании принимали участие 308 людей старше 65 лет. Тесты проводили с открытыми и закрытыми глазами, использовали европейский подход установки стоп на платформе — пятки вместе, носки врозь. Пациенты во время тестирования не использовали вспомогательные средства передвижения. Были выявлены гендерные различия у пациентов моложе 85 лет в скорости V (р0,01) и площади S (р0,01) статокинезограммы, а у людей в возрасте старше 85 лет — значимые отклонения скорости V центра давления в тестах как с открытыми, так и с закрытыми глазами (р0,05). Эти данные коррелируют с высокой частотой падений [61,4% (95% ДИ 45,5–75,6)] в данной возрастной группе. У пациентов с редкими (другими) переломами выявлены отклонения среднего направления колебаний при проведении пробы с открытыми глазами (р0,05). Не было выявлено статистически значимых различий стабилометрических показателей у пациентов старше 65 лет с переломами бедренной кости и вертебральными переломами (р0,05). Таким образом, метод стабилометрии может быть использован у людей пожилого возраста для раннего выявления нарушения баланса тела и риска развития падений, что позволит предотвратить развитие переломов.

The purpose of the study was to analyze the frequency of detection of vitamin D deficiency in elderly people, identify clinically significant diseases, accompanied by a deficiency of vitamin 25(OH)D. A retrospective cohort study was conducted in 506 patients over 65 years of age (74,1±6,5 years). Patients were divided into three age groups: group A 65-74 years, group B 75-84 years, group C 85 years and older. The study of blood samples was carried out from September to May. The level of vitamin 25(OH)D was determined by the method of chemiluminescent immunoassay on the Abbott Architect 8000 analyzer (USA). Evaluation of vitamin 25(OH)D was performed according to the clinical recommendations of the Russian Endocrinology Association and the recommendations of the Russian Association for Osteoporosis. Among people older than 65 years, the average level of 25(OH)D was 20,9 ng/ml (range 2,3 to 70,5 ng/ml), 50% had vitamin D deficiency. With age, the proportion of patients with vitamin D deficiency increased more in the male population. Low values of vitamin 25(OH)D were more frequent in the spring. Arterial hypertension, obesity of varying degrees, sarcopenia increased the risk of vitamin D deficiency in 1,15-1,17-1,2 (р0,05-0,01) times, respectively. Oncological diseases in the anamnesis were accompanied by low parameters of vitamin 25(OH)D in blood serum (p=0,084).Цель исследования — анализ обеспеченности витамином D людей пожилого и старческого возраста, выявление клинически значимых заболеваний, сопровождающихся дефицитом витамина 25(OH)D. Проведено ретроспективное когортное исследование при участии 506 пациентов 65 лет и старше, средний возраст — 74,1±6,5 года. Пациенты были разделены на три возрастные группы: группа А — 65–74 года, группа В — 75–84 года, группа С — 85 лет и старше. Исследование образцов крови проводили в период с сентября по май. Уровень витамина 25(ОН)D определяли методом хемолюминесцентного иммуннологического анализа на анализаторе «Abbott Architect 8000» (США). Оценка показателей витамина 25(ОН)D выполнена согласно клиническим рекомендациям Российской ассоциации эндокринологов и рекомендаций Российской ассоциации по остеопорозу. У людей старше 65 лет средний уровень 25(ОН)D составил 20,9 нг/мл (диапазон 2,3–70,5 нг/мл), 50% лиц имели дефицит витамина D, 36% — недостаток. После 85 лет доля пациентов, имевших дефицит витамина D, возрастала, преимущественно мужчин. Наиболее низкие значения витамина 25(ОН)D встречались весной. Артериальная гипертензия, ожирение разной степени, саркопения увеличивали риск дефицита витамина 25(ОН)D в 1,15–1,17–1,2 раза соответственно (р0,05–0,01). Онкологические заболевания в анамнезе сопровождались низкими показателями витамина 25(ОН)D в сыворотке крови (р=0,084).

The paper presents data on the role of vitamin D and calcium in the function of many human organs and tissues. Lifestyle, dietary preferences, and insufficient physical activity contribute to the high prevalence of vitamin D and calcium deficiencies in the adult population of Russia, causing different diseases and abnormalities. The authors have worked out recommendations for the preventive use of vitamin D and calcium in healthy population, give consumption rates for these substances, and describe the clinical and laboratory signs of vitamin D deficiency and indications for screening. They also propose treatment regimens for vitamin D deficiency and depict the signs of intoxication in overdose. Particular emphasis is laid on the place of vitamin D and calcium in the therapy of osteoporosis.

The purpose of the study was to examine the problem of falls in the elderly. A prospective cohort study of 537 patients over 65 years using validated questionnaires and functional tests. 56,58 % of patients had at least one fall event in the 12 months prior to the observation. 82,76 % of all falls are over the age of 85 years. Significantly more patients younger than 85 years fell in the autumn and winter (to 17,64 and 25,93 %, respectively) and over the age of 85 years in 50 % of cases (95 % CI 28,2-71,8) fell summer. Polypharmacy and comorbid conditions increases the risk of falls. 32,89 % of people over 65 years in the fall received fractures. However, a fracture of the femoral neck in 60 % of cases diagnosed over the age of 85 years. Hypodynamy observed in 69,77 % of cases.Целью исследования было изучение проблемы падений в пожилом возрасте. В проспективное когортное исследование были включены 537 пациентов старше 65 лет, использованы валидизированные опросники и функциональные тесты. 56,58 % пациентов имели не менее одного случая падения за 12 мес до начала наблюдения, 82,76 % всех падений происходили в возрасте старше 85 лет. Достоверно чаще пациенты моложе 85 лет падали в осенний и зимний периоды (в 17,64 и 25,93 % случаев, соответственно), а в возрасте старше 85 лет в 50 % случаев (95 % ДИ 28,2–71,8) падали летом. Полипрагмазия и коморбидные состояния увеличивали риск падений. У 32,89 % людей старше 65 лет случай падения завершился периферическим или аксиальным переломом, причем перелом шейки бедренной кости в 60 % случаев выявлен в возрасте старше 85 лет. Гиподинамию наблюдали в 69,77 % случаев.

Our understanding of the multiple physiological and pathological functions of B-cells continues to expand at a fascinating rate. As pathogenic elements in the development of autoimmune diseases, B-cells have become the focus of new therapeutics. Based on the published data, rituximab, a chimeric monoclonal antibody to CD20, when used in combination with other agents (i.e., cyclophosphamide or methotrexate), appears to be a reasonable treatment option for refractory RA. There are now numerous case reports and small openlabel series using rituximab in many autoimmune diseases, others then RA. While these data must be interpreted with caution, they suggest that rituximab may be a promising addition to the therapeutic armamentarium in these diseases. However, additional controlled trials need to be conducted to confirm clinical efficacy, further define optimal dosage, response rates, comparative long-term efficacy, and treatment algorithm for rituximab in these patients.

The article presents the results of prospective longitudinal study. The aim of the study was to investigate influence of complex therapy with chondroitin sulfate on pain and functional disorders in elderly patients with knee osteoarthritis. The study shows sufficient decreasing of pain, stiffness and functional disorders with complex therapy with chondroitin sulfate in comparison with nonsteroidal anti-inflammatory drugs (NSAID) by the second month of therapy with stable effect the next 2 months. All patients decrease their NSAID intake by the end of the study. Satisfaction of complex therapy was high according to patient's and physician's opinion.

Цель. Определение эффективной дозы ибандроната для предотвращения внепозвоночных переломов. Дизайн. Принятая концепция годовой кумулятивной дозы (ГКД) послужила основанием для проведения метаанализа исследований ибандроната, оценивающих риски внепозвоночных переломов двумя независимыми группами под руководством A. Cranney (исследования MOBILE и DIVA) и S. T. Harris (BONE, MOBILE, DIVA, IV dose fracture study). Результаты. В метаанализе A. Cranney показано, что применение ибандроната в ГКД 12 мг или > 10,8 мг приводило к достоверному снижению риска внепозвоночных переломов через 2 года на 38% по сравнению с используемой ГКД 5,5 мг. По метаанализу S. T. Harris в группе, получавшей ибандронат в ГКД>10,8 мг, отмечено статистически значимое снижение риска всех клинических, всех внепозвоночных и основных внепозвоночных переломов на 28,8%, 29,9% и 34,4% соответственно по сравнению с группой плацебо. Выводы. Применение ибандроната в дозе 150 мг внутрь ежемесячно и 3 мг внутривенно ежеквартально способствует снижению риска как позвоночных, так и внепозвоночных переломов.

Screening of the population sample for articular pain and swelling.A screening questionnaire for detection of arthritides and arthralgias was filled in for each adult rural and urban citizen aged over 18 years from 15 RF regions. Rural population was covered with a complete examination, urban one was examined by formation of a representative sample from general population. The screening covered a total of 31424 persons, mean age of whom was 47.6 +/- 17.6 years. Among them 14001 lived in the cities and 17423 in the villages. 61% respondents were women.Prevalence of arthralgias in the population reaches 46%. While the symptoms alleviated with time in 8%, they became chronic in the rest. The articular complaints rate in the population is sex-related and depends on the age. In persons under 20 years arthralgia occurs in 9%. Urban citizens have articular pains more frequently than rural population--43 and 33%, respectively.Pilot results of the screening program demonstrate prevalence of arthralgias in Russia and the importance of joint pathology problem in Russia.