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NiSpAR is a non-interventional, multicenter study whose aim was to describe a cohort of patients with non-radiological axial spondyloarthritis (nr-axSpA) and approaches to its diagnosis in the Russian Federation.Material and methods. The study involved 20 research centers in different regions of the Russian Federation. The work consisted of two phases: retrospective data collection 12 months before enrolment in the study and prospective observation of patients in whom the diagnosis of nr-axSpA was confirmed (104 weeks).The study included 272 patients who met the inclusion and exclusion criteria (Full Analysis Set, FAS). The mean age of the FAS-population was 38.7±11.0 years. The diagnosis of nr-axSpA was confirmed in 159 (58.5 %) of the 272 patients. Of the remaining 113 (41.5%) participants, 57 (50.4%) did not have the information required to confirm the diagnosis, 34 (30.1%) did not have pelvic radiographs, and 22 (19.5%) did not fulfil the ASAS criteria for nr-axSpA.Results and discussion. The mean age of patients with nr-axSpA was 37.6±10.4 years, more than half of them (52.8%) were women. The median disease duration was 36 [12; 80] months. In half of the patients the disease duration was more than 2 years, in more than one third – less than 2 years. The median CRP and ESR values were 5.0 [2.0; 12.0] mg/l and 11.0 [5.0; 18.0] mm/h, respectively. The BASDAI averaged 3.5±2.0 and was >4 in more than half of the cases (64.2%). The mean ASDAS-CRP value reached 2.6±1.1. Only 1 in 5 participants (20.8%) had low axSpA activity, while in 61.1% it was high (44.7%) or very high (16.4%). An inactive state was found in a small number of patients (9.4%). Twenty two (13.8%) patients had treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) in anamnesis, and 21 (13.2%) patients were still taking them.Conclusion. The results of the retrospective phase of the study show that in real-life clinical practice in the Russian Federation there is a continued positive trend towards improving the diagnosis of nr-axSpA. The median duration of the disease at the time of enrolment in the study was 3 years. The frequency of use of magnetic resonance imaging has increased by more than 1.8 times. At the same time, practitioners still have difficulties in establishing the diagnosis of nr-axSpA and a shortage of bDMARDs for treatment of these patients.

Aim. Switching to another biologic with the same mode of action provides greater opportunity for long-term management of patients with rheumatoid arthritis (RA). In clinical practice, especially in the context of the COVID-19 pandemic, such switching occurred for non-medical reasons as well. However, there is no information about switching from interleukin 6 (IL-6) receptor (R) inhibitor to direct IL-6 inhibitor. Objective – to assess the efficacy and safety of therapy in RA patients, after switching from IL-6R inhibitors (tocilizumab (TOC), sarilumab (SAR)) to olokizumab (OKZ) for reasons not related to the loss of their efficacy or adverse events. Material and methods. In this retrospective cohort study efficacy parameters and routine biochemical data were analyzed using descriptive statistics – mean values with standard deviation for continuous parameters and absolute and relative frequency for binary variables. Adverse events (AE) were reported according to patient’s files. The statistical significance and changes of the analyzed variables by visits were determined using paired t-test. Fisher’s exact test or chi-square test was used to compare the proportion of patients with improvement/no change and of patients with worsening. All tests were 2-sided, and p

Purpose of the study. Evaluation of the diagnostic characteristics of the CA‑62 marker for epithelial carcinomas for detecting early‑stage prostate cancer in a double‑blind clinical study. This study is also focused on the possibility of using the CA‑62 antigen as an auxiliary tool for decision‑making in prostate cancer diagnosis.Patients and methods. A blinded clinical study was conducted on 325 clinically verified blood serum samples. This includes 144 prostate cancer samples, 79 generally healthy volunteers‑men and 102 samples from patients with benign prostatic hyperplasia (BPH). Quantitative determination of the total and free prostate specific antigen (PSA) levels, as well as the CA‑62 marker of serum samples was performed using the electrochemiluminescent immunoassay ECLIA Elecsys Total and Free PSA (COBAS, Roche Diagnostics GmbH, Germany, EU) and the chemiluminescent immunoassay CLIA‑CA‑62 (JVS Diagnostics LLC, Moscow, RF).Results. A comparison of the CA‑62 level with the results for total and free PSA, as well as other diagnostic methods (PCA3, PHI) for the analysis of the BPH and prostate cancer groups was performed. The results show that the CA‑62 marker has the highest PPV (94.4 %) and NPV (93.1 %). This may increase the reliability of the decision related to the presence of PC and be used by doctors as an argument as an argument for a prostate biopsy referral. It has been demonstrated that using the novel cancer marker CA‑62 makes it possible to detect up to 90 % of the early‑stage prostate cancer with 97.2 % specificity (AUC = 0.969).Conclusion. Using the CA‑62 marker as an auxiliary diagnostic method within the PSA “grey zone” (from 2.5 to 10 ng/ml) made it possible to significantly increase the accuracy of detecting the PC early stages at biopsy up to 93.1 %. It will help the doctors to effectively differentiate between prostate cancer and benign prostatic hyperplasia.

Aim. To analyze newly diagnosed diseases and features of the post-COVID course in patients after a coronavirus disease 2019 (COVID-19) within 12-month follow-up.Material and methods. A total of 9364 consecutively hospitalized patients were included in the ACTIV registry. Enrollment of patients began on June 29, 2020, and was completed on March 30, 2021, corresponding to the first and second waves of the pandemic. Demographic, clinical, and laboratory data, computed tomography (CT) results, information about inhospital clinical course and complications of COVID-19 during hospitalization were extracted from electronic health records using a standardized data collection form. The design included follow-up telephone interviews with a standard questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.Results. According to the ACTIV registry, 18,1% of patients after COVID-19 had newly diagnosed diseases (NDDs) over the next 12 months. Hypertension (HTN), type 2 diabetes and coronary artery disease (CAD) prevailed in the NDD structure. Comparison of the age-standardized incidence of NDDs (HTN, CAD, diabetes) in the post-COVID period in the ACTIV registry with NDD incidence in 2019 according to Rosstat and the expected incidence of NDDs according to the EPOHA study revealed that HTN, diabetes, CAD in patients after COVID-19 were registered more often as follows: HTN by 7,0 and 4,4 times, diabetes by 7,3 and 8,8 times, CAD by 2,3 and 2,9 times, respectively. NDDs most often developed in patients aged 47 to 70 years. Comparison of the actual and expected number of cases of newly diagnosed HTN, CAD and diabetes depending on age showed that the actual number of cases in the population of patients in the ACTIV register is significantly higher than expected for patients aged 45-69 years and for patients with hypertension or diabetes and aged

Although antibiotics (AB) are ineffective for the treatment of COVID-19, they are often prescribed to patients with the novel coronavirus infection (NCV) for a variety of reasons. They include the difficulty of excluding bacterial co-infection at the first contact with the patient, as well as the possibility of developing a secondary bacterial infection. The aim of the work is to assess the frequency and background of prescribing antibiotics to hospitalized patients with confirmed COVID-19. Material and methods. A retrospective analysis of 160 hospital records of patients with confirmed COVID-19, who were treated in various Infectious Diseases Departments during the period from September to October 2020, was carried out. The selection was done by the method of random sampling. The analysis did not include the records of patients admitted to the ICU for NCV. Results. Information about the appointment of antibacterial drugs before hospitalization was found in 109 patients, of which only 51 patients did not receive AB on an outpatient basis. The remaining 58 (53.2%) patients began taking ABs on their own or based on the recommendation of an outpatient doctor, including 31 patients who took two or more drugs (successively or simultaneously). The most commonly used antibiotics were: macrolides (37 patients), cephalosporins (24 patients), respiratory fluoroquinolones (12 patients), and aminopenicillins (5 patients). On admission, AB was prescribed for almost all patients, except for one. The most frequently prescribed antibiotics were: macrolides (61%), mainly azithromycin, and respiratory fluoroquinolones (54.1%), mainly levofloxacin. In most cases, these drugs were combined with 3rd or 4th generation cephalosporins. Most patients received more than one AB: two drugs were prescribed to 86 (54.1%) patients, three — to 34 (21.4%) patients. AB therapy was carried out for a long time: the maximum number of days for macrolide administration (excluding previous AB therapy at the outpatient stage) was 16 days, respiratory fluoroquinolones — 22 days,3rd generation cephalosporins — 19 days,4th generation cephalosporins — 17 days, carbapenems — 34 days. In almost 100% of cases, ABs were prescribed on the first day of admission of patients, and their therapy continued until the patient was discharged from the hospital. Conclusion. The appointment of antibiotics at the hospital stage was established for the vast majority of patients in the absence of clear indications for their appointment. Such a frequent prescription of antibiotics is accompanied by a number of problems: immediate – side effects of such therapy (for example, antibiotic-associated diarrhea), long-term — an increase in antibiotic resistance of microorganisms.

Aim. To investigate on post-COVID period in patients of the Eurasian region.Material and methods. A total of 9364 consecutively hospitalized patients were included in ACTIV registry. Enrollment of patients began on June 29, 2020, and was completed on March 30, 2021, corresponding to the first and second waves of the pandemic. Demographic, clinical, and laboratory data, computed tomography (CT) results, information about inhospital clinical course and complications of COVID-19 during hospitalization were extracted from electronic health records using a standardized data collection form. The design included follow-up telephone interviews with a standard questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.Results. According to ACTIV register, 63% of patients after COVID-19 had new adverse symptoms or exacerbations of the existing symptoms lasting for up to 1 year. After hospital discharge, 79,8% of patients sought unscheduled medical attention in the first 3 months, 79,1% at 4-6 months, and 64,8% at 7-12 months. Readmission rate was 11,8% in the first 3 months, 10,9% at 4-6 months, and 10,1% at 7-12 months. The most common reasons for unscheduled treatment in the first 3 months were uncontrolled hypertension, decompensated type 2 diabetes, destabilization of coronary artery disease, gastrointestinal disease, AF episodes, exacerbation of asthma and chronic obstructive pulmonary disease, decompensated heart failure (HF). The 12-month mortality of COVID-19 survivors after the discharge was 3,08%. Multivariate analysis showed that independent risk factors for fatal outcome were age (direct correlation), the levels of hemoglobin (inverse correlation), oxygen saturation (inverse correlation), and aspartate aminotransferase (direct correlation), as well as class III-IV HF, prior stroke, cancer, inhospital acute kidney injury. Based on these identified risk factors, a nomogram was constructed to determine the 3-month mortality risk after discharge.Conclusion. Analysis of ACTIV register showed that end of the acute phase of COVID-19 does not imply a complete recovery.

Purpose of the study – to study the efficacy and safety of tenoxicam (Texared®) in patients with active axial spondyloarthritis.Material and methods. The study included 35 patients with active axial spondyloarthritis with BASDAI≥4.0. Patients were given continuous oral tenoxicam (Texared®, Dr. Reddy’s Laboratories) at a dosage of 20 mg/day. Subsequently, 5 patients were excluded from the study due to discontinuation of the drug after 5–10 days of administration. 30 patients were included in the final analysis. Initially and after 30 days, to assess the severity of pain and stiffness, activity, patients filled out questionnaires in electronic form using Google forms, a general assessment of pain in the lower back and the intensity of night pain by the patient, subjective sleep characteristics were carried out. The doctor calculated the BASDAI, ASDAS-CRP, BASMI indices, and evaluated the activity according to the doctor’s opinion. The baseline blood pressure level was determined, and a patient diary was issued for ambulatory blood pressure measurement in the morning/evening for 30 days. After 30 days, the patient’s ambulatory blood pressure control was assessed. At baseline and after 30 days, biochemical blood parameters were studied, including a complete blood and urine test.Results and conclusion. In patients with axial spondyloarthritis with high and very high activity, a positive effect of tenoxicam (Texared®) therapy on disease activity was noted. The effect of Texared® develops with regular use already during the first 2 weeks, and after 4 weeks there is a clear decrease in the severity of pain in the lower back, a decrease in the duration of morning stiffness. The drug is well tolerated, has a favorable safety profile, no serious adverse events and few side effects that do not require discontinuation of therapy.

Aim. To study the lipid profile in hospitalized patients with coronavirus disease 2019 (COVID-19) depending on the outcome of its acute phase according to the AKTIV international registry.Material and methods. The AKTIV registry included men and women over 18 years of age with a diagnosis of COVID-19, who were treated in a hospital. A total of 9364 patients were included in the registry, of which 623 patients were analyzed for levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides on days 1-2 of hospitalization. The level of high-density lipoprotein cholesterol (HDL-C) was calculated using the Friedewald equation.Results. We found that a decrease in LDL-C level was significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. This pattern persisted in both univariate and multivariate analyses. LDL-C levels in the final multivariate model had a significant relationship with the prognosis (an increase in the death risk by 1,7 times with a decrease per 1 mmol/l). In addition, we found that the survival of patients with an indicator level of

Aim of the study. Evaluation of treatment adherence in patients with rheumatoid arthritis (RA) and comorbidity.Materials and methods. One hundred thirty-two women (mean age: 55.5 ± 10.5 years) with proven RA (mean duration of disease: 10.2 [4; 14] years) were included in this study. Patients with moderate and high disease activity were prevalent (average DAS28: 5.0 [4.3; 5.8]). All patients had comorbidities. All patients underwent clinical examination, laboratory evaluation and imaging. Functional capacity was assessed using the Steinbroker classification (functional class — FC) and Stanford Health Assessment Questionnaire (HAQ). Pain severity was evaluated using visual analog scale (VAS). Patients’ social status was assessed. Baseline adherence to treatment was evaluated using two questionnaires. Morisky-Green questionnaire was used to evaluate general adherence to treatment among 132 (100%) patients. Quantitative evaluation of treatment adherence was performed in 82 (62.1%) patients using N.A. Nikolaev questionnaire.Results. Analysis of adherence to treatment as assessed by Morisky-Green questionnaire has established that 68 (52.3%) of patients are non-adherent to treatment. Low treatment adherence as assessed by Nikolaev questionnaire was found in 33 (40.3%) of patients. Lifestyle modification was characterized by lowest adherence. Young age, lower duration of disease and lower income were predictive of higher adherence to treatment. Non-adherent patients had higher RA activity index and lower functional capacity.Conclusion. Simultaneous use of several methods to assess treatment adherence is a reasonable way to get more information about the patient and to implement therapy as planned. Evaluation of baseline adherence to treatment among patients with rheumatoid arthritis allows to develop an optimal plan for follow-up and treatment control.

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period.

Systemic lupus erythematosus is a systemic autoimmune disease. Over the past decades, great success has been achieved in its treatment. However, mortality in systemic lupus erythematosus is still high. An adverse outcome may occur because of kidney damage, damage of the nervous system, severe hematological disorders, etc. The factor of unfavorable prognosis is infectious complications.The article presents a prospective clinical observation of a faytal case of severe course of systemic lupus erythematosus. The patient was treated in the rheumatology department of the State Regional Clinical Hospital in Saratov from 2007 to 2014.The presence of high disease activity, multiple system disorders — polyarthritis, lupus nephritis, hepatitis, leukopenia, and recurrent necrotizing cutaneous vasculitis required the administration of high doses of immunosuppressive drugs.The progressive course of the disease, resistance to hormonal therapy, the rapid development of infectious complications made the prognosis for the patient’s life extremely unfavorable. Persistent autoimmune leukopenia was the background condition for the development of complications. We used combined therapy — the oral administration of high doses of glucocorticoids together with intravenous injections (pulse therapy), broad-spectrum antibacterial drugs, intravenous immunoglobulin, drugs that improve tissue trophy and microcirculation. It was possible to decrease the disease activity, and also to restore the functional activity of the patient, to maintain low disease activity for 3 years, to prolong the life of a young patient by 8 years. The adverse combination of high activity of systemic lupus erythematosus with recurrent soft tissue infections caused difficulties for the therapy. Administration of adequate doses of cytostatic and biological agents were impossible due to leukopenia and secondary infection, which led to the death of the patient.

The international AKTIV register presents a detailed description of out- and inpatients with COVID-19 in the Eurasian region. It was found that hospitalized patients had more comorbidities. In addition, these patients were older and there were more men than among outpatients. Among the traditional risk factors, obesity and hypertension had a significant negative effect on prognosis, which was more significant for patients 60 years of age and older. Among comorbidities, CVDs had the maximum negative effect on prognosis, and this effect was more significant for patients 60 years of age and older. Among other comorbidities, type 2 and 1 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cancer and anemia had a negative impact on the prognosis. This effect was also more significant (with the exception of type 1 diabetes) for patients 60 years and older. The death risk in patients with COVID-19 depended on the severity and type of multimorbidity. Clusters of diseases typical for deceased patients were identified and their impact on prognosis was determined. The most unfavorable was a cluster of 4 diseases, including hypertension, coronary artery disease, heart failure, and diabetes mellitus. The data obtained should be taken into account when planning measures for prevention (vaccination priority groups), treatment and rehabilitation of COVID-19 survivors.

The organizer of the registers “Dynamics analysis of comorbidities in SARSCoV-2 survivors” (AKTIV) and “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2) is the Eurasian Association of Therapists (EAT). Currently, there are no clinical registries in the Eurasian region designed to collect and analyze information on long-term outcomes of COVID-19 survivors with comorbid conditions. The aim of the register is to assess the impact of a novel coronavirus infection on long-term course of chronic non-communicable diseases 3, 6, 12 months after recovery, as well as to obtain information on the effect of comorbidity on the severity of COVID-19. Analysis of hospitalized patients of a possible second wave is planned for register “AKTIV 2”. To achieve this goal, the register will include men and women over 18 years of age diagnosed with COVID-19 who are treated in a hospital or in outpatient basis. The register includes 25 centers in 5 federal districts of the Russian Federation, centers in the Republic of Armenia, the Republic of Kazakhstan, the Republic of Kyrgyzstan, the Republic of Belarus, the Republic of Moldova, and the Republic of Uzbekistan. The estimated capacity of the register is 5400 patients.

Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular diseases. To determine their daily arterial stiffness (AS) as an indicator of cardiovascular risk is of unquestionable interest.Objective: to evaluate the features of daily AS in RA patients with or without hypertension.Patients and methods. Twenty-four hour AS monitoring (24-h ASM) was done in 75 women with a valid diagnosis of RA. The patients were randomized into 3 groups: 1) 39 RA patients with hypertension; 2) 24 RA patients without hypertension; 3) 12 RA patients with masked hypertension. A comparison group consisted of 30 hypertensive patients without RA and a control group included 22 apparently healthy women who were age-matched with the patients with RA and those from the comparison group. 24-h ASM readings were studied using a BPlab device with Vasotens software (Russia).Results. All the patients with RA were found to have higher 24-h ASM readings than the controls; and, in the presence of hypertension, these changes were even more pronounced. Group 1 was noted to have higher ambulatory AS index than the comparison group; more than 70% of the patients in Group 2 were observed tohave increased aortic pulse wave velocity when reducing to a blood pressure (BP) of 100 mm Hg. The patients in Groups 1 and 2 had increases in augmentation index, in the latter normalized for a heart rate of 75 beats/min, in the propagation time of a reflected wave when reducing to a BP of 100 mm Hg, and in AS index at night. The patients with RA showed an association between daily AS and major cardiovascular risk factors (hypertension, age, body mass index, menopause duration), RA-specific risk factors (RA duration, erythrocyte sedimentation rate, and C-reactive protein), and psychoemotional status. Conclusion. 24-h ASM revealed that the patients with RA had higher vascular wall stiffness than the individuals in the comparison and control groups. Taking into consideration the pronounced changes in AS not only during the daytime, but also during the night, it is appropriate to perform daily monitoring in patients with RA in order to obtain more objective data.

Aim. To study the specifics of arterial hypertension (AH) taking the data from ambulatory monitoring (ABPM) in rheumatoid arthritis patients (RA).Material and methods. Totally, 105 women with RA included (mean age — 55,49±7,02 y. o., mean age of RA onset — 45,17±10,87 y. o., mean duration of RA — 10,79±10,01 y., activeness by DAS28 — 5±1,14). By the data from office BP, 2 groups were selected: first group — 56 patients with RA and AH (RA+AH), second group — 49 patients with RA, non-AH. Exclusion criteria were smoking, diabetes, secondary AH, associated clinical conditions of AH, exacerbated chronic conditions, pregnancy, lactation, malignancies. Comparison group included 30 females with essencial AH, non-RA and other inflammatory disorders of the joints and spine (mean age — 55,9±6,2 y. o.), controls consisted of 22 almost healthy volunteers (females, mean age — 54,13±6,25 y. o.). Patients underwent ABPM, laboratory investigations with total cholesterol, creatinine, C-reactive protein (hsCRP), ESR. The glomerular filtration rate (GFR) was calculated by CKD-EPI, activeness of RA by DAS28.Results. In general AH was found in 64,7% of RA patients, 11,4% were not aware of it, 57,3% did not control BP, and just 9,0% took 3-component antihypertension treatment. By ABPM, masked AH was found in 33,3% patients RA non-AH. Traditional risk factors in RA patients with essential and masked hypertension had same prevalence. By the ABPM data, RA hypertensives had worse nocturnal SBP profile comparing to AH and controls (p

The risk of cardiovascular events in patients with rheumatoid arthritis (RA) is higher than this in population in 3.96 times. Arterial hypertension (HT) is one of the modifiable risk factors. According to published data 10-30% of patients have "masked" HT, detectable by the daily monitoring of blood pressure (BP). According to our own study, the prevalence of "masked" HT among RA patients is 28.2%. Among hypertensive patients with RA 7.5% of patients had resistant HT, 36.8% - do not regularly control BP. During daily monitoring of arterial stiffness in RA patients with HT we revealed that outpatient stiffness index was significantly higher than this in patients with essential hypertension (p

Objective: to study the pattern and rate of comorbid diseases in patients with rheumatoid arthritis (RA) in the Saratov Region.Subjects and methods. The investigation enrolled 328 RA patients treated at the Rheumatology Unit, Saratov Regional Clinical Hospital, in 2011 to 2013. RA was diagnosed using the 1987 ACR criteria and the 2010 ACR/EULAR ones. The investigation included the patients receiving disease-modifying antirheumatic drugs (DMARD) at a stable dose for 3 months or longer. A questionnaire survey and objective examination were made in the patients; data from their medical records were taken into account.Results and discussion. Comorbidities were identified in 86.6% of the patients; 57.9% had a concurrence of two or more comorbid conditions. Osteoarthritis, hypertension, and coronary heart disease were detected in 50.7, 57.7, and 30.9% of the RA patients, respectively. Out of the inflammatory diseases, gastrointestinal tract lesion was most common (80.3%); urinary tract infections were slightly less common (19.7%).Conclusion. The high rate of comorbidity was noted in patients with RA. The pattern of comorbidities shows a preponderance of hypertension and osteoarthritis and an exacerbation of gastrointestinal and urinary tract diseases frequently makes the choice of DMARD difficult.

Objective: to study the rate and pattern of comorbidities in two groups of patients with rheumatoid arthritis (RA) in different follow-up years.Subjects and methods. The pattern of comorbidity was investigated in RA patients treated at the Rheumatology Unit, Saratov Regional Clinical Hospital, in different follow-up years. The investigation enrolled patients treated with disease-modifying antirheumatic drugs (DMARDs) in a stable dose for 3 months or longer. The patients were interviewed and objectively examined and the data of their outpatient medical records were taken into consideration. Group included 201 patients examined in 2006–2007. Group 2 comprised 328 patients examined in 2012–2013.Results. Comorbidities were ascertained in 67.2% of the patients in Group 1 and in 86.6% of those in Group 2. Two to five co-occurring diseases were more common in the examinees in 2012–2013 (66.9%) than in those in 2006–2007 (57%). The patients of both groups were most frequently found to have hypertension (60 and 57.7% of the patients, respectively) and osteoarthritis (OA) (71.1 and 50.7%). Out of the other diseases, the patients were most commonly found to have gastrointestinal tract (GIT) diseases (97.8 and 80.3%, respectively) and urinary tract infections (22.4% and 19.7%).Conclusion. The rate of comorbidities remains high in patients with RA. Among the comorbid diseases, there is a preponderance of hypertension, GIT diseases, and OA.

The paper describes 2 cases that demonstrate the patterns and specific features of infective endocarditis in the presence of hypertrophic obstructive cardiomyopathy, diagnostic difficulties, comorbidities, as well as error analysis and a disease outcome

We present a case of severe systemic lupus erythematosus (SLE) in 24-year-old woman. The specific features of the disease in this case were high disease activity, leucopenia, remitting ulcerative necrotizing skin vasculitis, secondary infectious complications. There was no other organic and haematological disorders typical for SLE, except leucopenia. Adequate treatment with high – dosage glucocorticoids in oral and glucocorticoid pulse-therapy, intravenous antibiotics, intravenous immunoglobulin, vasoactive therapy was successful and lead to decrease of inflammatory process.

Objective: to evaluate the basic and pleiotropic effects of atorvastatin in patients with rheumatoid arthritis (RA) and dyslipidemia (DLP).Subjects and methods. The blood lipid profile was studied in 204 patients with RA. According to the found lipid disturbances, the patientswere randomized into 2 groups. A study group comprised 30 patients receiving generic atorvastatin 10 mg/day as part of combination therapy.A comparison group included 20 RA patients matched for clinical characteristics and baseline lipid levels, who took no statins. Blood lipidparameters and the markers of inflammation, vascular wall damage, and artery rigidity were examined over time.Results. DLP was found in 58.3 % of the patients with RA. The use of atorvastatin in combination therapy resulted in not only a decrease in atherogenic cholesterol fractions, but also in a considerable reduction in the level of the markers of systemic inflammation and endothelial damage, and in disease activity. Six-month atorvastatin therapy showed a positive impact on the elastic properties of vessels in RA patients.Conclusion. In RA patients with DLP, atorvastatin exerted a beneficial effect not only on the blood lipid profile, but also on the magnitude of inflammation and the elastic properties of vessels, and disease activity.

In 2013, Russia registered officially the indications for the use of monoclonal antibodies to B-lymphocytes (rituximab, RTM) in systemic vasculitides associated with antineutrophil cytoplasmic antibodies (ANCA-SV). This communication presents the preliminary results of the Russian register of the RTM application in autoimmune diseases (NORMA) that has included 50 patients with ANCA-SV treated in 14 cities of the Russian Federation. Twenty-five of 50 (50%) patients received repeated courses of RTM. RTM has demonstrated a high efficacy and a good profile of treatment safety in patients with ANCA-SV in real-life national clinical practice. Among 25 patients who had been followed up for over 12 months, the remission was achieved in 92% of cases, a decrease in the ANCA-SV activity was observed in 8%. The efficacy of RTM increased when performing repeated courses, while it has been noted that the positive results can be obtained by prescribing a repeated course of RTM at a reduced dose (500–1000 mg). Prescription of the repeated courses was primarily required in patients with granulomatosis and polyangiitis affecting the lungs. Care should be taken when combining RTM treatment with cytostatics (primarily with cyclophosphamide) because of the risk of secondary immunodeficiency and infectious adverse events (AE), which have been the most frequent serious AE (12%) in patients with ANCA-SV.