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Interleukin (IL) 6 is one of the key cytokines whose role in the inflammation development in rheumatoid arthritis (RA), is well proven. The pleiotropic effects of the cytokine and biologic agents that inhibit its action have been studied much worse. The review provides information on the effects of IL-6 and blocking its signaling pathway on adipose tissue, glucose metabolism and adipocytokine levels in RA. It has been shown that prolonged blockade of IL-6 receptors does not lead to the adipose tissue accumulation and improves glycemic control, although it is not clear whether such effect is associated only with the anti-inflammatory properties of tocilizumab and sarilumab. Moreover, the mechanism of this beneficial effect is not fully understood, since the data on increased sensitivity of peripheral tissues to insulin during tocilizumab treatment are ambiguous. Perhaps changes in the relationship of adipocytokines or hormones play a certain role.

Objective – to identify obesity/overweight phenotypes in patients with systemic lupus erythematosus (SLE) based on the body mass index (BMI) and serum leptin levels assessment, and to clarify the relationship of these phenotypes with different metabolic disorders.Material and methods. The study included 51 patients with SLE (48 women, 3 men) without diabetes mellitus. The median age of patients was 40 [31; 48] years, disease duration was 3.0 [0.6; 9.0] years. Glucocorticoids were received by 84% of patients, hydroxychloroquine – by 76%, immunosuppressants – by 20%, biological agents – by 10%. BMI was calculated and the fasting leptin level in serum was determined (ELISA) in all patients. Leptin concentrations >11.1 ng/ml in women and >5.6 ng/ml in men corresponded to hyperleptinaemia. There were three main obesity/overweight phenotypes: “classic” (BMI≥25 kg/m2 + hyperleptinemia), “healthy” (BMI≥25 kg/m2 , without hyperleptinemia), “hidden” or “latent” (BMI˂ 25 kg/m2 + hyperleptinemia), as well as “normal weight” (BMI˂ 25 kg/m2 , without hyperleptinemia).Results. The “classic” phenotype of obesity/overweight was diagnosed in 22 (43%) patients, the “healthy” – in 1 (2%), the “hidden” – in 14 (27.5%) patients with SLE. Insulin concentrations were: 10.0 [7.5; 17.9] μU/mL in the “classic” phenotype, 8.3 [6.0; 11.9] μU/mL in the “hidden” phenotype, and 5.3 [4.2; 6.3] μU/ml at “normal weight” (p=0.001). HOMA-IR index were: 2.18 [1.70; 4.23], 1.78 [1.23; 2.41] and 1.18 [0.95; 1.52], respectively (p=0.002). The levels of glucose, total cholesterol, ApoB did not differ in the groups. The uric acid concentrations were the highest in the “classic” phenotype group (334 [365; 388] μmol/l), the lowest in the group of “hidden” obesity/overweight (257 [214; 296] μmol/l), and intermediate in “normal weight” group (286 [236; 377] μmol/l) (p=0.04).Conclusion. The majority of SLE patients hade the “classic” obesity/overweight phenotype, while the “healthy” phenotype was extremely rare. In 27.5% of patients, the presence of a “latent” phenotype was confirmed, which, in terms of metabolic disorders, is an intermediate stage between “normal weight” and “classic” obesity. For rational and timely prevention of insulin resistance, metabolic syndrome and related complications, it is necessary to actively identify the “hidden” phenotype.

Objective: to study the frequency of hyperleptinemia in patients with systemic lupus erythematosus (SLE), its relationship with clinical and laboratory manifestations of the disease, drug therapy, and other metabolic disorders.Patients and methods. The cross-sectional study included 46 women with a definite diagnosis of SLE (median age 40 [31; 48] years) and disease duration 3.0 [0.9; 9.0] years. Glucocorticoids (GC) were received by 38 (83%) patients, hydroxychloroquine – by 35 (76%), immunosuppressants – by 10 (22%), biologic disease-modifying antirheumatic drugs – by 5 (11%). In all patients, fasting levels of glucose, leptin, apoliproprotein B (ApoB) and immunoreactive insulin were determined, and homeostatic model assessment for insulin resistance (HOMA-IR) was calculated. Concentration of leptin ≥11.1 ng/ml, ApoB – >1.6 mg/ml were considered an elevated level. HOMA-IR index ≥2.77 corresponded to the presence of insulin resistance (IR).Results and discussion. Hyperleptinemia was found in 34 (74%) patients with SLE, an increased level of ApoB – in 19 (41%), IR – in 10 (22%). In patients with hyperleptinemia, serositis, positivity for anti-double-stranded DNA (aDNA) and hypocomplementemia were less common, overweight and obesity were more frequent, the SLEDAI-2K index was lower, the aDNA level was lower, and the concentration of the C3 component of complement, insulin, HOMA-IR index, body mass index (BMI) and disease duration were higher (p

Aim of the study was to clarify the body composition in patients with early rheumatoid arthritis before starting therapy with synthetic basic anti-inflammatory drugs, genetically engineered biological drugs and glucocorticoids using dual-energy X-ray absorptiometry and to assess the effect of inflammation and metabolic syndrome on body composition.Material and methods. The study included 37 patients (31 women and 6 men) with early rheumatoid arthritis. The control group consisted of 19 healthy donors without rheumatic diseases. Patients with rheumatoid arthritis and the control group were measured by waist size, height and weight, and body mass index was calculated. Body composition was determined by means of dual-energy X-ray absorptiometry using the “Whole Body” program on the HOLOGIC device (USA). The presence of metabolic syndrome was assessed according to the criteria of the International Diabetes Federation (IDF).Results. Patients with early rheumatoid arthritis had less lean tissue mass, which was negatively correlated with inflammatory markers (ESR and C-reactive protein levels). Overweight and obesity were diagnosed in 24% and 27% of patients with early rheumatoid arthritis, respectively. Patients with rheumatoid arthritis and metabolic syndrome had a higher body weight, body mass index, waist size, and adipose tissue mass than patients without metabolic syndrome. With the help of instrumental methods, it is shown that in rheumatoid arthritis there is a redistribution of fat mass in the body, its predominant accumulation in the trunk area and a parallel decrease in the volume of muscle tissue.Conclusion. Rheumatoid inflammation and metabolic syndrome affect body composition of patients with early rheumatoid arthritis before the start of antirheumatic therapy.

Objective: to determine body composition (BC) in women with systemic lupus erythematosus (SLE), by using bioimpedance analysis.Patients and methods. The investigation enrolled 12 women with a reliable diagnosis of SLE, who were followed up at the Clinic of the V.A. Nasonova Research Institute of Rheumatology. Their median age was 46.5 [38.5; 54.7] years. All the patients underwent estimation of waist circumference (WC) and body mass index (BMI). BC was analyzed using an InBody 770 multi-frequency bioimpedance analyzer (Biospace Co. Ltd, South Korea) at the Clinical Nutrition Clinic, Federal Research Institute of Nutrition and Biotechnology.Results and discussion. BMI corresponding to overweight or obesity was observed in 67% of patients; abdominal obesity (AO) was seen in 83%. BC study showed that in most patients, adipose tissue mass was greater than the normal values (75%), lean body mass, skeletal muscle mass, and the amount of body water were within normal limits (83%), and the basal metabolic rate was reduced (67%). There were positive correlations between the percentage of adipose tissue and BMI (r=0.9; p

Objective. To clarify the frequency of insulin resistance (IR) in patients with systemic lupus erythematosus (SLE), traditional and associated with rheumatic disease risk factors for its development, to assess the possibility of using the Finnish Type 2 Diabetes Risk Assessment Score (FINDRISC) questionnaire to detect IR.Material and methods. The cross-sectional study included 49 patients with SLE (46 women, 3 men) without diabetes mellitus and hyperglycemia, observed at the V.A. Nasonova Research Institute of Rheumatology in 2019–2020. The median age of the patients was 40 [33; 48] years, the duration of the disease was 3.0 [0.7; 8.0] years. Glucocorticoids (GC) were received by 41 (84%) patients, hydroxychloroquine – by 38 (78%), immunosuppressive drugs – by 10 (20%), biological agents – by 5 (10%). The glucose and fasting immunoreactive insulin levels were examined, and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index was calculated in all patients. HOMA-IR value ≥2.77 corresponded to IR. Traditional risk factors for type 2 diabetes and the risk of its development in the next 10 years in patients with SLE were assessed using the Russian version of the FINDRISC questionnaire.Results. The median HOMA-IR level in SLE patients was 1.7 [1.2; 2.5]. IR was detected in 10 (20%) of 49 patients with SLE. Patients with and without IR were comparable in terms of sex, age, duration and activity of SLE, therapy, and type 2 diabetes traditional risk factors. BMI, WC and insulin levels were higher in patients with IR. HOMA-IR correlated with body mass index (BMI) (r=0.6; p

Objective: to clarify the primary incidence of type 2 diabetes mellitus (DM) in patients with rheumatoid arthritis (RA) and to compare the prevalence of traditional risk factors (RFs) in groups of patients with and without carbohydrate metabolic disorders.Patients and methods. A retrospective analysis was carried out in 158 patients with RA (diagnosed at the age of 45 years and older; the disease duration was more than 12 months). The exclusion criteria were concomitant type 1 DM and type 2 DM that was diagnosed before or at the onset of RA. The patients' median age was 62 [57; 68] years. Most RA patients had moderate (41.8%) and high (39.9%) DAS28. New cases of type 2 DM and the presence of hyperglycemia were recorded at the time of the examination. The traditional RFs of type 2 DM were assessed using the Finnish Diabetes Risk Score (FINDRISC).Results and discussion. The incidence rates of type 2 DM was 9.3 per 1000 patient-years. The patients with developed type 2 DM versus those without DM had a larger number of RFs according to the the FINDRISC questionnaire (6 [5; 7] and 5 [4; 5]; p

The morbidity of diabetes mellitus is steadily increasing worldwide. Most of the patients with type 2 diabetes, many of whom already have complications when diagnosed. Strategy and tactics of treatment of patients with DM2 today are one of the priorities of modern medicine.

Objective: to determine the incidence of insulin resistance (IR) in patients with rheumatoid arthritis (RA) and to assess the relationship of IR to blood lipid profile changes and the presence of metabolic syndrome (MS).Subjects and methods. The investigation enrolled 47 RA patients (41 women and 6 men) without a history of diabetes mellitus (DM) and with normal fasting glucose levels during examination. The patients' median age was 56 [39; 62] years; disease duration – 6 [5; 14] years. Most of the patients had low (40.4%) or moderate (42.6%) RA activity (DAS28). IR was diagnosed using the Homeostastic Model Assessment of Insulin Resistance (HOMA-IR) index 2.77. The presence of MS was assessed by the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATPIII) criteria and the International Diabetes Federation (IDF) criteria.Results and discussion. The median HOMA-IR value in RA patients was 1.7 [1.1; 3.2]. The HOMA-IR index correlated with age (r=0.3; p=0.04), body mass index (r=0.6; p3.0 (40.0 and 6.3%, respectively; p

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

In recent decades, there has been a steady increase in the prevalence of diabetes mellitus (DM) worldwide, including Russia. Much attention has been customarily focused on micro- and macrovascular complications in DM; however, in its long and/or severe course, the complications may involve other organs, including the musculoskeletal system and skin. The involvement of these tissues in DM is largely explained by excessive production of advanced glycation end products. The paper considers the main rheumatic manifestations of DM: limited joint mobility syndrome, cheiroarthopathy, Dupuytren's contracture, trigger finger, adhesive capsulitis of the shoulder joint, rotator cuff injury, carpal tunnel syndrome, Charcot neuro-osteoarthropathy, osteoporosis, muscle infarction, and diabetic scleredema. The pathogenesis and diagnosis of DM and its possible therapy options are discussed.

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

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

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

Objective: to reveal irreversible organ damages and to establish factors that influence their development in a RENAISSANCE cohort of patients with systemic lupus erythematosus (SLE) admitted to the clinic of the V.A. Nasonova Research Institute of Rheumatology in the period 2012 to 2014.Subjects and methods. The investigation enrolled 231 young (mean age, 34.91±11.10 years) patients (209 women and 22 men) with a mean SLE duration of 107.65±97.36 months. On admission of the patients, the investigators collected history data (disease duration, the number of exacerbations and hospitalizations during the follow-up period), assessed current disease activity by SLEDAI-2K, irreversible organ damages by SLICC damage index (DI), and the therapy performed.Results and discussion. Irreversible organ damages were absent in 95 (41%) patients; one or more damages associated with both disease itself and the therapy were observed in the other (59%) patients. There were low (1), mean (2–4), and high (>4) SLICC DI values in 64 (28%), 62 (27%), and 11 (5%) patients, respectively. Ocular lesions were most common (35%); a significant proportion of patients were found to have damages to the cardiovascular (22%), musculoskeletal (19%), and nervous (10%) systems. Lung disease, diabetes mellitus, and cancer were less prevalent (6.0, 3.4, and 1.3%, respectively). The patients with damages were significantly older (p = 0.02), had a longer disease duration (p = 0.0005) and more frequent SLE exacerbations and hospitalizations (p = 0.0003 and p = 0.001, respectively). The patients with DI ≥1 received glucocorticoids (GCs) longer (p = 0.001). At the onset of SLE they had significantly higher doses of GCs (mean 44.06±18.97 mg) than those without damages (35.91±20.12 mg; р = 0.002). DI correlated with GC doses at the onset of the disease, duration of GC use, number of hospitalizations and exacerbations. There was also a statistically significant correlation of overall SLICC DI with the duration of disease (r = 0.23) and the total dose of cyclophosphamide (CP) (r = 0.19).Conclusion. Irreversible organ damages are present in 59 patients in the RENAISSANCE cohort. Older individuals develop a larger number of damages, with higher frequency of exacerbations and hospitalizations, longer use of GCs, and higher cumulative dose of CP. DI correlates with the dose of GC and does not depend on the activity and clinical manifestations of SLE at its onset.

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

The paper presents a brief review of the proceedings of the 15th Mediterranean Rheumatology Congress that was held in Istanbul, Turkey, in August 2014. This congress unites the scientists and physicians of Mediterranean countries and focuses the attention of rheumatologists and allied health professionals on the geographical and ethnical features of the pattern of human diseases caused by the inflammatory and metabolic involvement of the locomotor apparatus, as well as the peculiarity of the course of rheumatic diseases and treatment response. The goal of the congress is not only to present information on the latest advances in rheumatology, but also to create conditions for the academic exchange of knowledge at an international level and for the promotion of new investigations.

Proinflammatory cytokines involved in the pathogenesis of rheumatoid arthritis (RA) are able to inhibit the production of insulin and to cause insulin resistance in peripheral tissues. Conceivably RA increases the risk of developing carbohydrate metabolic disturbances (CMDs), such as diabetes mellitus (DM), fasting hyperglycemia (FH), and impaired glucose tolerance. Patients with a concurrence of RA and DM belong to a category of the most critically ill patients with a poor prognosis of macro- and microvascular complications.Objective: to estimate the rate of CMDs (DM and FH) in a cohort of patients with RA and their possible impact on the course of arthritis.Subjects and methods. The investigation enrolled 165 patients (28 men and 137 women) aged 55 [47; 61] years who were diagnosed with RA and followed up at the V.A. Nasonova Research Institute of Rheumatology. The patients who were seropositive for rheumatoid factor and anti-cyclic citrullinated peptide antibodies were 86.3 and 78.8%, respectively. RA activity was low in 29.1% of the patients, moderate in 48.5%, and high in 22.4%. Glucocorticoids (GC) were taken at a mean dose of 5 [5; 7.5] mg/day by 40.6% of the patients; methotrexate, leflunomide, and genetically engineered biological agents were used by 72.7, 8.5, and 23.7%, respectively. A survey was conducted among the patients to find out their awareness of the presence of CMDs and fasting venous plasma glucose levels were determined to screen for hyperglycemia. Height and weight were measured and body mass index (BMI) was calculated.Results. CMDs were present in 21 (12.7%) of the 165 patients with RA. Only 11 (6.7%) of the 165 patients were aware of having DM (2 cases with type 1 DM and 9 with type 2 DM); laboratory tests revealed CMDs in the remaining 10 patients (8 cases with FH and 2 with type 2 DM). The patients with DM and FH had a large number of tender joints (TJN) and high scores of general health survey (GHS) and DAS28 than those with normal blood glycose levels, but did not differ in RA duration, acute-phase indicators (erythrocyte sedimentation rate, C-reactive protein), and the number of swollen joints. Fifty-seven (34.5%) patients were overweight and 39 (23.6%) were obese. In the patients who took GC, glucose levels were lower (5.1 [4.7; 5.5]) than in those who did not (5.4 [5.0; 5.9] mmol/l; p = 0.001) and correlated with BMI ((r = 0.3; p = 0.01).Conclusion. The investigation demonstrated the high rate of DM and FH in RA, but low patient awareness of these conditions, as well as the relationship of CMDs to arthritis activity mainly due to the changes of subjective indices (GHS and TJN). The intake of GC and BMI may affect blood glucose levels in RA.

The peak onset of rheumatoid arthritis (RA) is at 30-55 years of age. At this age, the patients have also other concomi- tant diseases (comorbidities) that affect the course and prognosis of RA, the choice of its treatment policy, quality of life of the patients. Objective: to identify the most important and common comorbidities in patients with RA. Subjects and methods. Two hundred patients (median age 55 [46; 61] years) were enrolled; there was a preponderance of women (82.5%) with median disease duration 5 [1; 10] years, seropositive for IgM rheumatoid factor (83.0%) and anti-cyclic citrullinated peptide antibodies (81.6%) with moderate and high disease activity (median DAS28 value 3.9 [3.1; 4.9]). Varying degrees of destructive changes in hand and foot joints were radiologically detected in 71.2% of the patients; 64.5% of the patients had Functional Class II. Methotrexate was given to 69.5% of the patients; therapy with biological agents was used in 21.0% of the cases. 15.5% of the patients did not receive DMARD or biologics. 43.0% of the patients with RA received glucocorticoids. Results. Comorbidities were present in 72.0% of the patients with RA. The most common diseases were hypertension (60.0%), dyslipidemia (45.0%), fractures at various sites (29.5%), and coronary heart disease (21.0%). Myocardial infarction and stroke were observed in 1.5 and 1.0% of cases, respectively. There was diabetes mellitus (DM) in 7.5% of the cases and osteoporosis in 15.5% of the patients. 81.7% of the patients with RA and hypertension and 80.0% of those with RA and DM received antihypertensive and sugar-lowering therapy, respectively. At the same time the RA patients with dyslipidemia and osteoporosis received specific drugs far less frequently (30.0 and 29.0%, respectively). Conclusion. Comorbidities are frequently encountered in RA. By taking into account the fact that cardiovascular dis- eases are a main cause of death in RA; it is necessary to adequately and timely modify traditional risk factors (hyper- tension, dyslipidemia, and diabetes mellitus). Treatment patients with RA requires an interdisciplinary approach and an interaction between physicians of different specialties.

Functional lesions of organs depend on the size of a diseased vessel and frequently require the use of intensive therapy methods. The commonest manifestation of antiphospholipid syndrome (APS) is deep vein thrombosis of the leg and pulmonary thromboembolism (PTE).Objective: to estimate the frequency of lung lesions in primary APS (PAPS), secondary (in the presence of systemic lupus erythematosus (SLE)) and catastrophic APS and to assess a relationship between lung pathology and other clinical and laboratory manifestations of the disease.Subjects and methods. The study covered 372 patients followed up at the Institute of Rheumatology, Russian Academy of Medical Sciences, since 1990, of whom 290 and 82 patients had SLE and PAPS, respectively. Among the 290 patients with SLE, there were 96 males and 194 females. At the moment of the study, the patients’ age was 31.2±11.1 years and the duration of the disease was 8.6±7.2 years. The group of patients with PAPS comprised 20 males and 62 females. Their mean age was 35.6±9.9 years and the duration of the disease was 11.9±8.5 years. Thrombotic events were verified only by instrumental studies. Lung pathology was instrumentally confirmed; all the patients underwent lung X-ray study, if required, scintigraphy and computed tomography.Results. Lung lesion associated with the pathology of vessels was revealed in 28% of the examined patients (105/372). There were prevalent patients with PTE, followed by the development of lung infarcts, which was present in 96 (91%) of the 105 patients with pulmonary vascular pathology. Autopsy revealed pulmonary microangiopathy was in 12 patients, which was concurrent with focal pneumonia in 7 of them, with pneumonitis and exudative pleuritis in 5. Hemorrhagic alveolitis detected at autopsy in combination with occlusions of the pulmonary arterioles was in 3 patients who had been diagnosed as having thromboembolism of small branches of the pulmonary artery. Thrombosis of the pulmonary arterial trunk was detectable in 2 patients, both patients died from respiratory failure. All 105 patients with pulmonary vascular pathology had blood serological markers of APS. There was a combination of elevated levels of aKL and VA in 61% of cases and in 28.5% in the group of patients without pulmonary vascular pathology (OR = 3.92; [2.38-6.48]). The rate of vascular lung pathology increased in the presence of both blood aKL isotopes (IgG and IgM). The number of patients position in both aKL isotopes was 48% whereas in Group 2, that was 19.5% (OR = 3.76; [2.24-6.31]).Conclusion. More than a fourth of the patients with SLE and PAPS have pulmonary vascular pathology. The spectrum of pulmonary vascular diseases in SLE is broad and varies from thrombosis of the pulmonary arterial trunk to occlusive vascular lesion of the microcirculatory bed of the lung, and it is associated with aFL.