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Currently, the list of microorganisms that have a possible connection with the development of rheumatoid arthritis continues to be updated. The role of not only traditional pathogens, but also representatives of conditionally pathogenic microflora is being actively studied. A number of domestic and foreign works demonstrate a high degree of Helicobacter pylori infection in patients with rheumatic diseases, including rheumatoid arthritis.The aim of the present study is to identify the frequency of detection of Helicobacter pylori infection in patients with rheumatoid arthritis and in adult residents of the city of Tula.Material and methods. The study included 3288 residents of Tula who do not have rheumatic diseases, and 119 patients with rheumatoid arthritis. To detect the infection, FEGDS was performed according to the generally accepted method with the taking of biopsies of the mucous membrane of the antrum and the stomach body, followed by verification of Helicobacter pylori using the Helpil-test test system.Results. According to the results of the data on the infection rate of residents of Tula without rheumatic diseases (n=3288), the largest percentage of infected (78.8%) was detected by an invasive method – express diagnosis of urease activity of the biopsy. The detection rate using a respiratory ammonia test and serological method was lower and amounted to 51.1 and 49.3%, respectively. In total, H. pylori was detected in 1692 people, which was 51.46%. Among patients with rheumatoid arthritis, Helicobacter pylori infection was 81.5%. Signs of damage to the mucous membrane of the upper gastrointestinal tract were often detected: superficial and subatrophic gastritis, single erosions.Conclusions. 1. Based on the study, it was found that the infection rate of Helicobacter pylori in patients with rheumatoid arthritis is at a fairly high level, not significantly different from that in residents without rheumatic diseases, when examined by an invasive method – express diagnosis of urease activity of the biopsy (81.5% and 78.8%, respectively). 2. Among patients with rheumatoid arthritis, there was a tendency to increase the frequency of infection with age and peak values in older age groups (r=0.37; p˂ 0.05). 3. The frequency of detection of erosive and ulcerative lesions of the gastrointestinal tract in infected and uninfected Helicobacter pylori patients with rheumatoid arthritis significantly differed (42.2 and 13.6%) (p=0.03).

To date, there are numerous studies on the effect of COVID-19 on the course of autoimmune rheumatic diseases and the value of vaccination in preventing this dangerous viral infection.Objective: to assess the effect of coronavirus infection on the course of rheumatoid arthritis (RA), the severity of infection, the effect of current baseline therapy on infection outcomes, and the role of vaccination against COVID-19.Patients and methods. 134 patients with a reliable diagnosis of RA were interviewed and their outpatient records analysed during the pandemic period from January 2020 to July 2021.Results. Most of the patients were in the older age group (62.7 years on average), had an average disease duration of 13 years, low to moderate RA activity, comorbidities including arterial hypertension, excess body weight, type 2 diabetes mellitus, etc. All patients received synthetic basic anti-inflammatory drugs (BАID) and glucocorticoids (GC). Thirtyseven (27.6%) patients were vaccinated with the Sputnik V vaccine. Their adverse events were represented by soreness at the injection site (n=6) and transient flu-like syndrome (n=6). Worsening of joint syndrome was reported by 1 patient. COVID-19 was suffered by 43 patients, none of whom were vaccinated. 7 patients were hospitalized, 3 patients died (all had severe comorbidities). In the post-infection period, weakness (64%), memory impairment (48.7%), reduced ability to work (38.5%) persisted for a long time (42 days on average), which was due to the long withdrawal of BАID.Conclusion. No exacerbations of the disease were noted in those vaccinated with Sputnik V. COVID-19 was detected in 43 (32.1%) patients, 7 of whom required hospitalization and 3 died. Exacerbation of RA in the post-infection period was associated with prolonged withdrawal of BАID.

Over the past decades, there has been an increase in the incidence of asymptomatic hyperuricemia (AHU), which includes an increased level (>360 μmol/L) of uric acid (UA) in the blood serum of patients with no clinical manifestations of gout. AHU is reported in various rheumatic diseases, mainly in osteoarthritis, in which AHU is one of the manifestations of the metabolic syndrome. There is relationship between AHU and pulmonary hypertension in systemic sclerosis, arterial hypertension (AH) in men with seronegative rheumatoid arthritis, extensive cutaneous psoriasis and metabolic disorders in psoriatic arthritis. There are almost no data on AHU in ankylosing spondylitis (AS), which served objective for this work.Objective: to assess the association of AHU with AS duration and activity and the presence of comorbid diseases.Patients and methods. A retrospective analysis of 48 medical histories of patients with diagnosed AS, who were treated in V.A. Nasonova Research Institute of Rheumatology from 2015 to 2019 years, whose serum UA level was >360 μmol/L.Results and discussion. More than half of patients with AS and AHU were overweight, 21% were obese. AH was diagnosed in 43.7% of patients. Stage II–III chronic kidney disease was detected in 16.7% of patients, urolithiasis – in 18.8%. 4 (8.3%) patients had diabetes mellitus. The serum UA level in patients with AS was 422.0 ± 61.6 μmol/L. In patients with AS, an association between AHU and age, duration and disease activity was noted. There was no statistically significant rela- tionship between HG and blood glucose, cholesterol, creatinine levels, body mass index. Correlation analysis revealed a statistically significant relationship between the glomerular filtration rate (GFR) and the age of patients (r=-0.54, p0.05).Conclusion. In AS, an association between an increased level of UA in the blood serum and the duration and activity of the disease, and patient's age, was established.

Currently, the problem of reactive arthritis (ReA) retains its importance due to the fairly high prevalence of the disease, primarily in Russia. Analysis of epidemiological data allows us to put forward a number of possible reasons explaining the different frequency of ReA in certain regions of the Russian Federation and in other countries. The lecture describes the clinical picture of the disease, as well as analyzes the significance of various laboratory techniques aimed at identifying the causative agent of ReA. The Russian diagnostic criteria for ReA are presented. The main approaches to the therapy of ReA are outlined with an emphasis on the use of antimicrobial drugs. The effectiveness and safety of drug immunocorrection (inducers of interferon, polyoxidonium, immunofan, etc.) in the treatment of urogenital chlamydia in patients with ReA have not been confirmed by data from randomized controlled trials.

Viral infections, hepatitis B and C and herpesvirus-induced infections in particular, are widespread in the population. Recent years have seen the emergence of new viral infections that were previously endemic. Understanding the role of viruses in the pathogenesis of rheumatic diseases (RDs) is of great importance. First, they cause the clinical manifestations characteristic of many RDs (systemic lupus erythematosus, rheumatoid arthritis, polymyositis, and Sjö gren's disease). The author discusses several possible mechanisms of the involvement of viruses in the development of autoimmune disorders: molecular mimicry; polyclonal B cell activation with overproduction of antibodies and immune complexes; T cell activation with cytokine overproduction. Secondly, viral infection can be reactivated during immunosuppressive therapy (also using biological agents), which is widely used to treat RDs. The review presents data on both the most common viruses (hepatitis B and C viruses, HIV, and human herpesviruses types 1–6) and more rare ones (chikungunya virus and polyomavirus) in the Russian population.

Hematidrosis is a rare disease. Isolated cases are described in the literature, which makes it impossible to study the etiology and pathogenesis of the disease. The most convincing are the assumptions about the role of emotional stress in the clinical manifestations of the disease. The author presents his own 2-year observation of a girl who periodically had bleeding from the nose and ear canal.

According to statistics from the Ministry of Health of Russia, the incidence of reactive arthropathies varies significantly by region and year. In ICD-10, reactive arthropathies include reactive urogenic arthritis (M02.3), other reactive arthropathies (M02.8), and reactive arthropathies, unspecified (M02.9). Information on reactive arthritis (ReA) cannot be extracted from these data.Objective: to specify the number of patients with ReA among inpatients with reactive arthropathies.Patients and methods. A retrospective analysis of 224 case histories was made in the patients treated at the V.A. Nasonova Research Institute of Rheumatology Clinic in 2009–2018 and discharged with Codes M02.3, M02.8, and M02.9.Results and discussion. Nineteen out of the 224 patients were diagnosed with reactive urogenic arthritis (M02.3), 128 had reactive arthropathies (M02.8), and 77 had reactive arthropathies, unspecified (M02.9). All the 19 patients with this diagnosis met the criteria for reactive urogenic arthritis. Among the 128 patients with reactive arthropathies, 77 met the ReA criteria, 8 of them were found to have reactive urogenic arthritis, since the clinical picture had a triad consisting of arthritis, urogenic or enterocolitic infection, and conjunctivitis. Twenty-five out of the 77 patients discharged with Code M02.9 met the criteria for certain ReA and 6 did those for possible ReA. Thus, the diagnosis fitted the criteria for ReA in only half (56.7%) of the patients with reactive arthropathies.Conclusion. The performed investigation revealed that clinicians paid insufficient attention to the diagnosis of ReA and that statisticians did this to the coding of reactive arthropathies.

Objective: to analyze trends in the incidence and prevalence of major rheumatic diseases (RDs) among the adult population of Russia in 2013 to 2017.Material and methods. The trends in the incidence and prevalence of major RDs were analyzed among the adult population of Russia over 5 years (in 2013 to 2017) according to the statistical reports of the Ministry of Health of Russia, which are based on the data of accounting form No. 12 “Information on the number of diseases recorded in patients living in the region served by a health care facility”. The analysis was carried out in eight Federal Districts (FDs).Results and discussion. Over 5 years, there was a slight increase in the number of patients (by 21,677) with musculoskeletal diseases (MSDs) among the adult population of Russia and a small (0.64%) decrease in their prevalence. Noninflammatory osteoarticular diseases, such as osteopathy, chondropathy, deforming dorsopathies, and arthropathies (74%), were leading among MSDs. The incidence of osteoarthritis (OA) was highest: more than 4 million people, which is a quarter of all RDs. The increase in the number of patients with OA was observed annually, but was insignificant for 5 years – 190.400 people; the prevalence of OA increased by 3.7%. The largest number of patients with OA was registered in the Central (1.1 million) and Volga (0.9 million) FDs.The incidence of rheumatoid arthritis (RA) increased insignificantly in the Central, Northwestern, Southern, Ural, and Siberian FDs and decreased in the Volga and Far Eastern FDs. There was a substantial (21%) decrease in the prevalence of RA in the North Caucasian FD. There was a significant increase in both the incidence and prevalence of spondylopathy (SP) in almost all FDs, except for the Volga FD. In contrast, these indicators for reactive arthritis (ReA) had decreased in five FDs by 2017 and slightly increased in three FDs. These indicators fluctuated in almost all FDs for 5 years.The incidence and prevalence of psoriatic arthritis (PsA) showed a annual increase particular in the North Caucasian FD by 29%. The incidence of PsA slightly decreased only in the Siberian FD. The number of patients with systemic connective tissue diseases (SCTD) increased insignificantly in all FDs, with the exception of the North Caucasian FD, in which the prevalence of SCTD reduced dramatically (by 42%). The incidence of osteoporosis (OP) fluctuated during 5 years; by 2017, there had been its rise in five FDs, especially in the Northwestern FD. The prevalence of OP was found to increase significantly (by 33.5%) in the North Caucasian FD.Evaluation of the age composition of patients showed that OA and OP were more common in the older age group; and ReA; SP and SCTD were in the younger age one. There were no differences in the age composition of patients with RA.Conclusion. The analysis of the statistical incidence and prevalence rates of RDs in the adult population of Russia suggests that there is an increase in the number of patients with this pathology throughout the country.

In a number of cases, systemic therapy for rheumatoid arthritis (RA), including disease-modifying anti-rheumatic drugs, biological agents, glucocorticoids (GCs), and nonsteroidal anti-inflammatory drugs, fails to completely suppress joint inflammatory changes in the patients. Therefore, local methods are widely used in the combination therapy of RA. Intra-articular injection of hyaluronic acid (HA) is a highly local treatment modality. HA can be used as initial therapy when it is necessary to achieve rapid clinical improvement, or at a later stage of the disease, in exacerbation of arthritis. However, in some patients the effect of intra-articular HA can be short-lasting, and a favorable result can be obtained with local radiotherapy. It is based on powerful irradiation of the inflamed synovium, which is provided by intra-articular injection of radioactive isotope colloids. In Russia, RA was successfully treated with colloidal Au-198, but its production was ceased in the 1990s, and agents for radioisotope synovectomy have been long unavailable.Tungsten-188/Rhenium-188generator has been recently designed in Russia, which allows Rhenium-188 to be obtained in clinics. Preclinical trials have shown that intra-articular injection ensures good fixation of the drug in the knee joint with its insignificant accumulation in the liver and other non-target organs and tissues. Introduction of this drug into routine clinical practice can markedly improve the efficiency of treatment in patients with chronic arthritis.

Objective: to evaluate the efficiency of combination therapy with methotrexate (MTX) and hydroxychloroquine (HC) in rheumatoid arthritis (RA) in real clinical practice.Patients and methods. The investigation enrolled 430 patients with documented RA who had been followed up for 16 weeks by rheumatologists in different regions of the country. Individual schedules were filled out for the patients, by adding demographic, clinical, and laboratory parameters that made it possible to assess the activity of the disease and to estimate the level of glucose, cholesterol, and low-density lipoproteins (LDL). The results of the investigation were evaluated at the inclusion of patients in it and then at 8 and 16 weeks. Taking into account the insufficient previous effect of MTX, the treatment was enhanced by HC.Results and discussion. By the end of the investigation, the combination therapy with MTX + HC led to significant decreases in the number of swollen and tender joints, the duration of morning stiffness, the severity of pain, and the integrated DAS28 index. The therapy showed a positive effect on the levels of fasting glucose, cholesterol, and LDL. The quality of life improved in patients by Visit 3. The results obtained are in good agreement with the data by foreign and Russian investigators on the greater efficiency of combination therapy with MTX + HC than that of MTX monotherapy and on the pleiotropic (hypolipidemic and hypolipidemic) effect of HC.Conclusion. It is concluded that in Russian practice when monotherapy with MTX shows an insufficient effect or its high doses cannot be administered to enhance the efficacy of RA therapy, it is possible to use a combination of MTX + HC, especially in older patients with comorbidity (hyperglycemia and hypercholesterolemia).

Due to the development of synovitis, early-stage hand osteoarthritis (HOA) mimics hand joint injury in rheumatoid arthritis (RA). However, the topography of synovitis is diverse in these diseases: distal interphalangeal and thumb joints are involved in the process in HOA. In the latter, tests are negative for immunological markers (anti-cyclic citrullinated peptide antibodies), which is typical of RA. The differences between HOA and RA are prominent, as evidenced by hand X-rays and magnetic resonance imaging. Investigations suggest that cytokine profile imbalance is implicated in the pathogenesis of osteoarthritis, which brings it closer to RA. However, therapy for HOA has not been practically developed; there are only a few works on the use of disease-modifying antirheumatic drugs and biological agents in these patients. It is necessary to work out Russian guidelines for the treatment of HOA.

Objective: to assess trends in the overall and primary incidence of rheumatic diseases (RD) from by visit rates in Russia in 2015–2016.Material and methods. The incidence rates were analyzed on the basis of the data presented in the reports of the Ministry of Health of Russia on adult mortality rates in 2015 and 2016.Results and discussion. The analysis of adult morbidity rates associated with musculoskeletal diseases (MSDs) revealed a certain downward trend in Russia over 2015–2016. The total number of registered patients with this pathology in 2016 amounted to 16.6 million people, which were 266 thousand people less than in 2015. The primary incidence of MSDs showed a decline by 55 thousand people in this period. The reports of the Ministry of Health indicate that the entire group of patients with MSDs in the section «Rheumatology» has data on six nosological entities: rheumatoid arthritis (RA), reactive arthropathies (RAP), spondylopathies (SP), systemic connective tissue disease (SCTD), osteoarthritis (OA), and osteoporosis (OP). In the RD group OA accounted for the highest incidence rates (4,350,465 cases in 2015 with some reduction (4,285,464 cases) in 2016). In 2015 and 2016, the incidence of RA was 50,905 and 76,823 cases; that of SP was 110,855 and 115,442 cases; that of RAP was 50,905 and 76,823 cases; that of SCTD was 62,265 and 58,276 cases; that of OP was 155.107 and 155,624 cases, respectively. psoriatic arthritis (PsA) accounted for the lowest incidence rates (18,069 and 19,229 cases). The Russian Federation annually registers more than 600 primary cases of OA per 100,000 adult population; less frequent were RA (27.2), SP (18.2), OP (10.2), and RAP (13.5); SCTD and PsA were much less diagnosed (5.9 and 2.84, respectively). Noteworthy are significant variations in the overall and primary incidence in both federal districts and one federal district, making it difficult to attribute only to climatic and geographical factors. This is most likely to be associated with a shortage of trained rheumatologists in individual subjects of the Russian Federation. In addition, it is necessary to monitor the correctness of the diagnosis and its encoding in accordance with ICD-10.

Ankylosing spondylitis (AS) is a socially significant rheumatic disease that generally starts in young adults and, if untreated, often leads to temporary incapacitation, and by 40 years, and to disability. Despite the relatively young age of patients, the course of AS is accompanied by a number of comorbidities that most commonly include hypertension, dyslipidemia, and involvement of the gastrointestinal tract and kidney. The main group of drugs recommended for the treatment of the disease is nonsteroidal anti-inflammatory drugs (NSAIDs) that, when used long, exert analgesic, anti-inflammatory, and even disease-modifying effects on the one hand and can cause adverse reactions on the other. When choosing NSAIDs, one should consider not only the activity of the pathological process, but also the presence of comorbidities in the patient. The paper gives data on the efficacy and safety of nimesulide in AS. The drug has proven its efficacy and safety in various rheumatic diseases over nearly a quarter century of its use in Russia.

The analysis covering the five-year period (2010–2014) showed that the adult population of the Russian Federation showed increases in the incidence of rheumatoid arthritis (RA), estimated per 100,000 population, by 5%, in that of spondylopathies (SP), osteoarthritis (OA), and osteoporosis (OP) by 32.2, 12.1, 7.3%, respectively, and an 8.6% decrease in that of only reactive arthropathies (ReA); the incidence of psoriatic arthritis (PsA) and systemic connective tissue diseases was virtually unchanged with increment of 1.3 and 0.3%, respectively. Our attention is engaged by the high incidence of RA (300.7) in the North Caucasian (NC) Federal District (FD) with a considerable increment (+30%) over the 5 years and by that in the Volga (V) FD throughout the analyzed period (342.4 in 2014). The incidence of SP higher than Russia's average was noted in the NCFD (124.5) with a 48.4% increment by 2014 and in the Far Eastern FD (136.1 with a 47.5% increment); and that was especially high in the Crimean (C) FD (380.0). The incidence of ReA remained constantly high in the NCFD (as high as 129.0 in 2014); on the contrary, it turned out to be very low in the CFD (7.8%). Only the NCFD showed a higher than average incidence of PsA (59.0) throughout the analyzed period in Russia. In 2014 the incidence of OA below Russia's average was seen in the NCFD (1893.3) and CFD (1875.8). The high incidence of OP was observed in the Ural (148.9) and Siberian (228.2) FDs. At the same time it was low in a number of FDs: the Southern FD (54.1), NCFD (68.7), and VFD (89.9) and very low in CFD (36.7).

Reactive arthritis (ReA) is one of the types of spondyloarthritis. According to the statistics reports by the Ministry of Health of Russia, the prevalence of ReA in 2013 was 42.8 per 100,000 adult population, 99, and 172.4 per 100,000 children aged 0–14 and 15–17 years, respectively. There is a wide scatter of ReA detection rates in both the federal districts and subjects of the Russian Federation, which may be associated with both the spread of sexually transmitted infections, asymptomatic trigger Chlamydia infection, and overdiagnosis of ReA.

At present, the problem of reactive arthritis (ReA) remains relevant in rheumatology. This is due to rather high prevalence of the disease primarily in Russia, which cannot but alarm. Analysis of epidemiological findings suggests a number of possible explanations for variability of ReA incidence rates in some regions of the Russian Federation and other countries. The lecture details the clinical presentations of the disease and analyzes the significance of different laboratory procedures aimed at detecting the pathogen of ReA. It presents Russian diagnostic criteria for ReA. It also sets forth basic approaches to ReA therapy with emphasis on the use of antimicrobial drugs. The efficiency and safety of drug immunomodulation (interferon inducers, polyoxidonium, immunofan, etc.) in treating urogenital Chlamydia infection in ReA patients are not confirmed by the data of randomized controlled trials. In this connection, it is impossible to give any recommendations for their use in urogenic ReA.

Ankylosing spondylitis (AS) is a chronic systemic disease of the axial skeleton. Recently, there has been increased interest among practitioners and researchers in AS. Because of difficulties in conducting epidemiological surveys studying statistical data on its prevalence and patient mortality is of great importance. It permit introduction of necessary corrections into organization of medical care to patients on the basis of analysis of the situation in the region.Objective: to study the trend and validity of data on AS prevalence and patient mortality in the adult population of the Tula Region versus the Russian Federation.Subjects and methods. The investigators used the 2002–2010 statistical guidelines “Prevalence of diseases in adult populationof Russia” by the Ministry of Health of Russia; the 2006–2010 federal statistical inquiry forms No. 14 in the Tula Region and the Russian Federation; the European hospital database; the 2000–2011 mortality databases in the Tula Region, which had been obtained by the automated mortality registration systems, which contained 373,997 records and included all margins of “Medical Death Certificates”.Results and discussion. In the Russian Federation, overall prevalence of AS per 100,000 adult population increased from 27.6 in 2002 to 34.4 in 2010 (the increment was 24.6%) while in the Tula Region its trend was unstable in this period. Incidence of AS here decreased by 31.8% from 2002 to 2010; in Russia its increment was 51.6%. From 2000 to 2011 in the Tula Region AS was registered as one of the causes of death in 29 cases.Conclusion. To plan measures aimed at improving the quality of medical care to AS patients, it is necessary to expand a comprehensive study of AS prevalence as well as outpatient and inpatient mortality from AS

Methotrexate or leflunomide is used as a first-line synthetic disease-modifying anti-rheumatic drug in the therapy of rheumatoid arthritis (RA). In 2011, the Russian Federation registered and since it has been successfully using leflunomide**.Objective: to evaluate the efficacy and tolerability of leflunomide** used to treat RA in routine clinical practice.Subjects and methods.The investigation enrolled patients with varying duration of RA that met the 1987 classification criteria. The patients were followed up in 33 healthcare facilities of Russia from March 2013 to October 2014. A total of 235 patients were randomized; the data of 196 patients were statistically processed. The mean age of the patients was 52.4±11.8 years; the mean duration of the disease was 75.4±69.1 months. The disease activity estimated by DAS28 and CDAI were 5.5±1.2 and 35.1±14.3 scores, respectively. 105 and 57 patients had X-ray Stages II and III disease, respectively. 80.1% of the patients were positive for rheumatoid factor and anti-cyclic citrullinated peptide antibodies. According to the instruction of its use, leflunomide was administered in a dose of 100 mg/day during the first 3 days and then in that of 20 mg/day. When adverse reactions (ARs) occurred, it was recommended that the daily dose of the drug was decreased to 10 mg. The patients were examined before and 1, 3, and 6 months after treatment. The investigators measured the number of tender joints (NTJ) and that of swollen joints (NSJ), and visual analog scale (VAS) pain intensity, performed a laboratory examination involving clinical blood test, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), in patients during their visits to physicians. The disease activity was assessed with DAS28 and CDAI and ARs were recorded.Results. Six-month therapy reduced the mean NSJ from 10.9 to 7.5%, NTJ from 12.3 to 8.9, VAS pain intensity from 64.1 to 39.3 mm, on average, ESR from 37.04 to 23.6 mm/hr, and CRP from 27.8 to 12.35 mg/l. By 6 months of therapy, low and moderate RA activities estimated by DAS28 were noted in 70.9% of cases and those by CDAI in 61.2%. No serious ARs were detected during the study.Conclusion. The findings suggest that leflunomide shows a good clinical efficacy and tolerability.

The incidence of major rheumatic diseases was analyzed inRussia's adult population in 2012–2013 on the basis of the statistical reports of the Ministry of Health ofRussia(Form No. 12).Among the adult population ofRussia, the overall incidence of acute rheumatic fever (ARF) decreased by 11.6% (from 1666 to 1474 cases). No case of ARF was registered in 11 of the 83 subjects of the Federation in 2013. The inci- dence rates per 100,000 adult population compared toRussia's ones were higher in theRepublicofIngushetia(21.0%), theChechen Republic(13.2%), and the Chukotka Autonomous District (26.2%). All cases of ARF were first notified. The overall incidence rates of chronic rheumatic heart diseases amongRussia's adult population tend to reduce slightly [by 5.3% (from 182,286 to 172,687 cases)].In the period in question, the total number of patients with musculoskeletal diseases (MSD) slightly rose. The bulk of rheumatic patients from the MSD group are more than 4 million patients with osteoarthritis (OA), half of them (2,454,563) being those who are older than able-bodied age. The incidence of OA tends to increase in all Federal Districts (FD). The most common joint inflammatory diseases are rheumatoid arthritis (RA) (286,000 cases), spondylopathies (90,000 cases), and osteoporosis (152,000 cases). The incidence rates of MSD per 100,000 adult population are higher in the North-Western (19,397.7), Volga (16,552.6), and Siberian (16,133.4) FD thanRussia's mean rate (14,205.5). There were somewhat higher incidence rates of RA per 100,000 population in 2013 than in 2012 (241.4 and 245.6, respectively). The rates in the North-Western, Ural, Far Eastern, and Volga FDs are higher than the mean Russian ones.In 2011, the rubric of «Ankylosing spondylitis» (AS) was replaced by that of «Spondylopathies» that, besides AS (ICD-10 M45), encompasses other inflammatory spondylopathies (M46), including infectious one, which does not allow single out the spinal inflammatory diseases under a rheumatologist's competence. InRussia, there were 39,800 patients with AS in 2010 and as many as 89,000 patients with spondylopathies in 2013.The incidence of systemic connective tissue diseases (SCTD) remains rather stable. Unfortunately, SCTDs include different nosological entities (sys- temic lupus erythematosus, systemic sclerosis, systemic vasculitides, etc.), which cannot refine trends in the incidence of specific diseases.In a number of the Federation's subjects, the incidence rate of reactive arthritis (ReA) is higher thanRussia's mean one. It is not inconceivable that not only arthropathies caused by prior enteric and urogenital infection are taken as ReA, leading to the hyperdiagnosis of ReA.The incidence of osteoporosis varies in FDs: from 226.5 per 100,000 adult population in the Siberian FD to52.0 inthe Southern FD, which is most likely to be associated with the fact that an instrumental examination cannot be made in patients to detect this pathology.DOI: http://dx.doi.org/10.14412/1995-4484-2015-120-124

Objective: to study how clinical characteristics of ankylosing spondylitis (AS) affect working efficiency.Subjects and methods. Authors examined 220 patients with AS (162 males and 58 females). Mean age was 35.1±9.5 years, mean age of the disease manifestation – 30.0±9.7 years. Median duration of AS was 73 [5; 396] months. Activity of the disease was high (BASDAI and ASDAS values 4.6±2.1 and 3.3±1.3 respectively). BASFI was increased to 4.1±2.6, HAQ – 0.98±0.64. Work productivity was assessed with WPAI (Work Productivity and ActivityImpairment) questionnaire by four aspects: absenteeism, presenteeism, general reduction in productivity (GRP) and activities of daily living (ADL).Results. Among 220 patients with AS, 133 were employed (60%). Median value of absenteeism comprised 0 [0; 85] %, presenteeism – 40.3±24.4%, GRP – 59.1±32.9%. Mean ADL was 49.8±26.6% less than normal. Inverse correlation was observed between absenteeism and AS duration (R=-0.22). BASDAI correlated with WPAI aspects: absenteeism (R=0.21), presenteeism (R=0.70), GRP (R=0.37) and reduction in ADL (R=0.73). The strongest correlation detected was that between WPAI aspects (R>0.5) and the intensity of pain assessed by visual analogue scale. BASFI index showed moderate correlation – with GRP (R=0.30) and close – with presenteeism and reduction in ADL (R=0.56 and R=0.71 respectively) and did not correlatewith absenteeism.Conclusion. AS activity was the main factor influencing work productivity. Presenteeism correlates with clinical characteristicsof AS considerably stronger than absenteeism. All WPAI aspects correlated with the disease activity and degree of functional impairment.

The paper gives data on the positive role of hyaluronic acid (HA) preparations in the treatment of knee and hip osteoarthrosis (OA). The clinical effect of intraarticular agents is not only due to their lumbricative, but also, to a greater degree, anti-inflammatory and chondroprotective activities. The efficacy of HA preparations do not practically depend on their molecular weight. Long-term HA cycles can delay the risk of joint replacement in OA.

Objective: to compare the clinical manifestations of coxitis with the data of HJ ultrasound study (USS) on inpatient samples.Subjects and methods. This cross-sectional study enrolled 220 AS patients meeting the modified 1984 New York criteria who had been consecutively admitted to the clinic of the V.A. Nasonova Research Institute of Rheumatology in 2012–2013. A specially designed schedule was filled out for each patient. Disease activity was measured by the BASDAI and ASDAS and functional status was assessed by the BASFI. Coxitis was diagnosed on the basis of clinical signs, such as HJ pain and/or movement limitations on patient admission to the clinic. All the patients underwent HJ USS.Results. The clinical signs of coxitis were found in 162 (73.6%) patients. In 107 (66%) of them, pain intensity recorded by the digital rating scale if only in one joint was 4 scores or higher. The patients with and without the clinical signs of coxitis were matched for age and disease duration. However, in coxitis, high disease activity was detected significantly more frequently and BASFI scores were also significantly higher. USS indicated that 119 (54%) patients had joint effusion. HJ effusion was found in 104 (63%) of the 162 patients with clinically manifest coxitis; and among the119 patients with USS verified coxitis, 87% were seen to have clinical signs of joint injury and 104 (47%) patients had both clinical and ultrasound signs of HJ injury simultaneously. USS revealed no signs of synovitis in 58 patients with the clinical signs of HJ lesion.Conclusion. Among the patients with AS, the rate of coxitis runs to 51%. The patients with coxitis have higher disease activity and more pronounced functional impairments than those without HJ injury. Coxitis causes considerably diminished working ability. In a number of cases, USS allows, when the clinical manifestations are similar, a differential diagnosis between synovitis and enthesitis located in this area. It is necessary to conduct additional studies to specify the upper limit of the normal range for the neck-capsular distance that is to be kept in mind when diagnosing coxitis by USS.

The All-Russian public organization «The Association of Rheumatologists of Russia» (ARR) is in the forefront of the history and present-day activity of Russian rheumatology. In 1928, the Committee on Rheumatism and Control was set up, which was essentially the predecessor to All-USSR (1964) and All-Russian (1987) research societies of rheumatologists, which were succeeded by ARR (1991). Today ARR is one of the largest and influential public health organizations in Russia, the activity of which has been able to sustain and strengthen a rheumatology service in the country and to train a highly experienced professional community rendering care for patients with rheumatic diseases. Innovative biological agents that could substantially improve treatment results have been recently designed. However, cardinal prognosis improvement is associated not only with the introduction of the innovative medicines, but also with the improvement of early-iagnosis-based pharmacotherapy strategy that determines the possible initiation of very early (a window of opportunity) active tightly controlled anti-inflammatory therapy whose goal is to maximally achieve active remission (to treat to target). ARR jointlywith European rheumatologists has been engaged in this international initiative shortly since its creation in 2010. Further training of rheumatologists has been one of the main tasks of ARR at all times. ARR has proposed a learningthrough-life model of continuing medical education, by involving rheumatologists at full-term and on-line advanced training cycles, seminars, schools, conferences, meetings, and congresses. At the website of the V.A. Nasonova Research Institute of Rheumatology there is a portal of education programs in rheumatology, which is available to all rheumatologists of the country. Today ARR unites not only rheumatologists, but also physicians of related professions: cardiologists, gastroenterologists, aftercare specialists, traumatologists/orthopedists, endocrinologists, neurologists, and psychiatrists. In the past decade, the All-Russian society of disabled people «Nadezhda (Hope) Association» has joined ARR in implementing its measures.

Efficacy and tolerability of soluble nimesulid (nimesil) 200 mg/day was assessed in 30 patients with rheumatoid arthritis during an 8-weeks controlled study. Nimesil showed significant analgetic and antiinflammatory effects confirmed by decrease of pain, swollen and painful joint count. Effect was considered as good in 77% of cases. The drug was withdrawn in 3 patients because of side effects (gastrointestinal in 2 and face oedema in I)