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The Association of Rheumatologists of Russia (ARR) is one of the largest and most influential public medical organizations in Russia, whose activities have allowed us to preserve and strengthen the rheumatology service in the country, train highly qualified personnel, and work productively and successfully for the benefit of our patients. Today we celebrate the 60th Anniversary of the ARR, we remember the history, the stages of a long journey and our achievements.

Dynamic monitoring of the patient's condition is a fundamental element of the modern strategy for the treatment of rheumatoid arthritis (RA), which aims to achieve remission or low inflammatory activity of the disease. A simple and informative indicator that can be used to assess treatment outcomes from a patient's perspective is the Patient Acceptable State Status (PASS).Objective: to determine the severity of patient-reported outcomes (PROs) and their relationship to the PASS indicator in patients with RA in reallife clinical practice.Material and methods. A one-time survey of 945 patients with RA was conducted in paper and electronic form from January to June 2023. The survey included the determination of PROs (pain, fatigue, anxiety, depression, activities of daily living, global assessment of health – GAH, – global assessment of disease activity – GADA) and PASS. The majority of patients were women – 87.8%, mean age – 46.3±13.2 years, median disease duration – 6 [3; 14] years. 80.4% of patients received synthetic disease modifying antirheumatic drugs, 23.9% – biologic disease modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi), 36.5% – glucocorticoids (GC), 82.8% – nonsteroidal anti-inflammatory drugs (NSAIDs).Results and discussion. According to the survey, the severity of joint pain (according to a numerical rating scale, NRS 0–10) was on average 5.3±2.6, fatigue – 6.2±2.6, GAH – 5.4±2.4, GADA – 5.4±2.7, median anxiety – 5 [3; 8], depression – 5 [2; 7], limitation of daily activity – 5 [3; 7]. Satisfaction with their health condition (PASS+) reported 54.8% of patients, dissatisfaction (PASS-) was associated with the presence of moderate/severe pain (NRS ≥4; odds ratio, OR 2.665; 95% confidence interval, CI 2.072–3.429; p ˂ 0.001), fatigue (OR 2.497; 95% CI 1.818–3.430; p ˂ 0.001), anxiety (OR 1.683; 95% CI 1.395–2.029; p ˂ 0.001). PASS- was statistically significant more common in patients taking NSAIDs and GCs and significantly less common in patients receiving bDMARDs and JAKi.Conclusion. PASS is associated with the main PROs (pain, fatigue, anxiety and depression) and can be used as one of the indicators for evaluating the effectiveness of RA treatment.

The formation of chronic musculoskeletal pain (MSP) is a multifactorial process, in its pathogenesis mechanism of central sensitization (CS) plays an important role.Objective: to evaluate the effectiveness of etoricoxib at a dose of 60 mg per day in diseases accompanied by moderate/severe chronic MPS, with an additional analysis of the effect of this drug on the manifestations of CS.Patients and methods. An open observational study, 790 patients (71.6% women, mean age 54.5±13.0 years) with osteoarthritis and chronic nonspecific back pain received etoricoxib 60 mg/day for 2 weeks. The dynamics of pain, dysfunction, fatigue, sleep disturbances, general health assessment (GHA) on a numerical rating scale (NRS 0–10), as well as signs of CS according to part A of the CSI questionnaire were assessed.Results and discussion. After 2 weeks, the intensity of pain during movement, at rest and at night decreased on average by 58.8±24.1, 69.7±32.6 and 70.1±32.8% respectively; functional insufficiency by 58.2±22.5%, fatigue by 52.2±25.8%, GHA by 50.0±22.6%, sleep improvement by 54.3±25.8% was observed (p

The modern strategy for the treatment of rheumatic diseases (RD) involves the fastest possible achievement of remission or low disease activity. However, even with the use of the most modern technologies and after a pronounced decrease in the inflammatory activity of the disease, it is not always possible to achieve a complete and stable remission. In such a situation, an important goal of treatment is to maximize the quality of life (QoL) of patients. Pain is one of the leading predictors of a decrease in QoL in patients with RD. At the same time, effective pain control can improve not only the course of individual symptoms of the disease, but also life prognosis as a whole. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most popular drugs for the symptomatic treatment of RD. At the same time, the administration of NSAIDs with a favorable safety profile can improve the quality of life of patients. Meloxicam is the first predominantly selective inhibitor of cyclooxygenase (COX) 2, which appeared in the arsenal of practitioners in the late 90s and has a strong evidence base for efficacy and safety.

Objective: to study the effect of neuropathic pain symptoms (SNP) on the clinical manifestations of rheumatoid arthritis (RA) in patients with moderate or high disease activity.Patients and methods. The 1st (main) group included 58 RA patients (84.5% of women, age 53.0±11.9 years), in whom SNP were identified using the DN4 (≥4) and PainDETECT (≥13) questionnaires. The 2nd (control) group included 43 patients with RA (79.1% women, age 48.8±14.4 years) who did not have SNP (DN4 ≤4 and PainDETECT ≤13). All patients received disease-modifying antirheumatic drugs (mainly methotrexate and leflunomide), 20% – biologic disease-modifying antirheumatic drugs. We compared groups 1 and 2 for RA activity (DAS28, CDAI, SDAI), pain intensity on a visual analogue scale (VAS, 0–100 mm), functional impairment (HAQ), patient global assessment (PGA, VAS), number of painful and swollen joints, quality of life (EQ-5D), signs of anxiety and depression (HADS), CRP level.Results and discussion. The RA activity in patients of the 1st and 2nd groups did not differ statistically significantly. Patients of the 1st group showed significantly higher indicators of the severity of pain, PGA and anxiety than patients of the control group: 71.0±12.5 and 54.7±17.5 mm, respectively (p

Non-steroidal anti-inflammatory drugs (NSAIDs) are the primary means of managing chronic osteoarthritis (OA) pain. The choice of NSAIDs is based on an analysis of the risk of adverse reactions (ARs). Objective: to evaluate the efficacy and safety of long-term use of NSAIDs for pain control in patients with OA in real clinical practice.Patients and methods. To assess the results of long-term use of NSAIDs in OA, a 12-month observational non-interventional study was conducted. It included 611 patients with knee, hip and generalized OA, and nonspecific back pain associated with OA of the facet joints. All patients were prescribed aceclofenac (Aertal®) 200 mg/day. The patients' condition was assessed 2 weeks, 3, 6, 9 and 12 months after the start of therapy. The following parameters were determined: the intensity of pain during movement and the general health assessment (GA) according to the visual analogue scale (VAS, 10 cm); pain intensity according to the Likert verbal rating scale (VRS) (0–4); the number of patients with a pain reduction of ≥50% from baseline; patients' assessment of the result of therapy according to Likert VRS (1–5). The development of ARs was recorded at each visit.Results and discussion. By month 12, 46.8% of patients had dropped out of observation. In patients who continued the study, the average severity of pain according to the VAS at baseline, after 2 weeks, 3, 6, 9 and 12 months was: 6.5±1.2; 4.8±1.4; 3.2±1.4; 2.6±1.4; 2.2±1.1; 1.4±1.1 cm, respectively (significant differences compared to the baseline for all points – p

Knee osteoarthritis (kOA) is a common cause of turning for medical advice, associated with chronic pain and disability. One of the methods of OA treatment is the local administration of hyaluronic acid (HA) drugs.Objective: to evaluate the effectiveness of intra-articular (IA) administration of highly purified HA (Armaviskon Plus) in kOA.Patients and methods. The study group consisted of 58 patients (74.1% women and 25.9% men, aged 59.5±11.8 years) with kOA, experiencing moderate/severe pain (≥40 mm on a visual analogue scale, VAS). All patients received IA injection of HA Armaviskon Plus (2 ml of a 1.5% solution), 2 injections with an interval of 7 days. The effectiveness criterion was the dynamics of pain at rest and during movement (VAS 0-100 mm) and the function of the knee joint according to a numerical rating scale (NRS 0-100 points) 2 weeks, 1 and 3 months after administration of therapy.Results and discussion. During the treatment, there was a significant improvement in all indicators. The average severity of pain during movement at baseline, after 2 weeks, 1 and 3 months was 50 [40; 60], 30 [20; 40], 15 [0; 30], 20 [0; 30] mm (p

Patient's satisfaction with treatment is a fundamental indicator of the quality of medical care, which is especially important for assessing the effectiveness of therapy for musculoskeletal pain in rheumatic diseases (RD).Objective: to determine satisfaction of patients with RD with pain relief therapy and to analyze the factors influencing the subjective assessment of analgesic therapy.Patients and methods. Anonymous survey of 1040 patients (age 55.8±14.0 years, 76.8% were women) with RD, rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthritis, systemic connective tissue diseases and gout, was carried out. The presence of pain and its therapy, satisfaction with treatment, and patient's opinion about the reasons of low pain relief effectiveness were assessed. The dependence of the presence of dissatisfaction with treatment on a number of demographic and clinical factors was analyzed.Results and discussion. 71.5% of patients experienced pain in one or more joint areas and/or in the back. 70.6% of patients used non-steroidal antiinflammatory drugs (NSAIDs), 1.6% – paracetamol, 40.0% – non-drug modalities and methods of alternative medicine. 15.6% of the respondents were completely satisfied with the treatment, 64.0% were partially satisfied, and 20.4% were completely dissatisfied. The main subjective reasons for the insufficient effectiveness of analgesic therapy were: fear of taking prescribed medications due to possible complications (45.4%), low effectiveness of drugs (15.7%), insufficient attention of doctors (20.3%). Male gender, body mass index >30 kg/m2 , severe pain, pain in several areas, and the diagnosis of OA were statistically significantly associated with treatment dissatisfaction. In contrast, patients with RA showed greater satisfaction with treatment.Conclusion. Most patients with RD are dissatisfied with the results of pain therapy. Educational work with patients and a personalized approach to prescribing analgesic therapy is needed.

Combating the consequences of COVID-19, a disease caused by the new coronavirus infection SARS-CoV-2, is a serious and very urgent task facing modern medicine. COVID-19 often has a severe course and is accompanied by multiple organ damage, systemic immune inflammation, coagulopathy, neuroendocrine and metabolic disorders. Even with a relatively favorable course, the consequences of SARS-CoV-2 infection can be degenerative changes in many organs (pulmonary fibrosis, cardiosclerosis), various functional and psychoemotional disorders. As a result, in 10–50% of patients, various unpleasant symptoms persist for a long time after the acute manifestations of COVID-19 subside and the virus is eliminated. This pathology is referred to as “post-COVID syndrome” (PCS). The main elements of PCS are chronic pain, fatigue, and psychoemotional problems. Functional disorders, autoimmune processes, and severe psychological distress after COVID-19 can cause the development and exacerbation of diseases characterized by chronic pain and fatigue, such as fibromyalgia and chronic fatigue syndrome. Therapy and prevention of PCS include correction of functional disorders, pain control, and consistent physical, psychological, and social rehabilitation.

25 years ago, a new non-steroidal anti-inflammatory drug (NSAID) – meloxicam (Movalis®) – entered the clinical practice of our country. This drug was the first embodiment of the concept of selective blockade of cyclooxygenase 2 – the main pathway followed by pharmacological science to create a safe NSAID. A series of large-scale, well-organized randomized controlled trials and observational post-registration studies have confirmed the good efficacy and low incidence of adverse reactions (ADR) when using meloxicam. In our country, this drug has become one of the most popular analgesics. Until now, the original meloxicam has enjoyed a high level of trust among Russian doctors and patients. The reason for this is a long and very extensive experience in the clinical use of meloxicam (over 25 years, 63.7 million packages of the original drug were sold, which means that millions of our Russian citizens were treated with it), as well as a large number of clinical studies conducted by Russian scientists. So, to date, there are 36 Russian studies (n=8498) assessing the efficacy and safety of the original meloxicam in a variety of diseases and clinical conditions. Practically all of these studies have shown good therapeutic results: on average, pain relief is 50–75% of the initial level; good or excellent assessment of the drug effect in 70–80% of patients. The incidence of HP was on average 10.5±5.4%, and there were no serious life-threatening complications. This review briefly presents the data of Russian and major foreign clinical studies, which studied the therapeutic potential and safety of meloxicam.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to control pain in rheumatoid arthritis (RA). However, many aspects of the therapeutic effect of NSAIDs in RA have not been sufficiently studied. In particular, this concerns the effect of NSAIDs on the inflammatory activity of the disease.Objective: to study the comparative efficacy and safety of NSAIDs in RA patients with moderate and low disease activity.Patients and methods. The study group consisted of 404 patients with RA, 69% women and 31% men, mean age 58.6±10.0 years, with moderate and low disease activity – DAS284 cm on the visual analog scale (VAS) 0–10 cm. All patients received DMARDs, mostly methotrexate 15 to 25 mg weekly, 8.2% biological agents, 18.6% glucocorticoids. All patients were prescribed NSAIDs at the full therapeutic dose. The results of treatment were evaluated after 2 weeks, 1, 3 and 6 months. Criteria of efficacy were the dynamics of pain (10 cm VAS), Patient Global Health (PGH on a 10-cm VAS), the change in the tender joints count (TJC) and swollen joints count(SJC), and dynamics of RA activity (DAS28).Results and discussion. 54.2% of patients received aceclofenac, 19.8% nimesulide, 14.3% meloxicam, 9.1% diclofenac, 2.6% – other NSAIDs. After 2 weeks, the pain decreased from 6.3±1.2 cm to 4.5±1.5 cm on VAS (p

The aim of the study was to study the quality of life of patients with alkaptonuria.Material and methods. The study included 50 patients with a reliable diagnosis of alkaptonuria aged 18 to 78 years (mean age 58.2±10.8 years). Among them, men predominated (n=31; 62%), in most cases (98%) complaining of pain in the joints and/or spine. For the first time, the articular syndrome debuted at the age of 17 to 39 years (average age of debut – 29.4±4.76 years). The duration of clinical manifestations of the disease before diagnosis ranged from 7 to 47 years (mean 23.35±8.17 years). 74% of patients had a disability group. In the study cohort, the body mass index (BMI) was slightly higher than normal values and averaged 28.18±4.95 kg/m2. The quality of life of patients was assessed using the EuroQol-5D questionnaire (EQ-5D).Results. The quality of life corresponding to a satisfactory state of health according to EQ-5D was observed in 56% of patients. Their quality-of-life index (LQI) values were more than 0.5. 22% of patients had 0

Effective pain relief in rheumatology practice is one of the most important criteria for the quality of medical care. Therefore, drugs with analgesic effects, primarily nonsteroidal anti-inflammatory drugs (NSAIDs), are among the most commonly used ones in the combination therapy of rheumatic diseases. All NSAIDs are capable of causing to one degree or another extent unwanted reactions that occur in the gastrointestinal tract (GIT), cardiovascular system (CVS), liver, kidneys, and allergic reactions. Considering the widespread use of NSAIDs, the problem of preventing these complications becomes not only medical, but also social. In 2008, the European Union launched the international project SOS (Safety Of non-Steroidal anti-inflammatory drugs) to study the safety of NSAIDs. The results of this project have shown that aceclofenac is one of the most successful drugs in combining the safety for GIT and CVS. Compared with other NSAIDs, this drug has a minimal risk for GI bleeding (relative risk (RR) 1.43; 95% confidence interval (CI), 0.65–3.15); it does not increase the risk of hospitalization for heart failure (RR, 1.03; 95% CI, 0.91–1.15) or the risk of developing myocardial infarction (RR 1.04; 95% CI, 0.90–1.19) either. The risk of ischemic stroke during aceclofenac therapy was slightly increased (RR, 1.17); but statistically insignificant (95% CI, 0.98–1.39). A large number of randomized clinical trials, meta-analyses, and observational programs have demonstrated that aceclofenac has pronounced analgesic and anti-inflammatory effects that are comparable to those of other NSAIDs and can be used in diseases accompanied by musculoskeletal pain, including that in older patients.

Aim. Evaluate the frequency, nature and course of PTP, as well as the effectiveness and safety of NSAIDs in PTP in real clinical practice. Materials and methods. The assessment of the condition and need for NSAIDs (original meloxicam) in 1115 outpatient patients who suffered a fracture of the radius (32.2%), injury to the knee (35.2%) or ligaments of the ankle (32.6%); women/men 51.5 and 48.5%, average age 46.915.5 years. We evaluated the dynamics of pain intensity (on a numerical rating scale NRS 010) at rest and during movement, the preservation of moderate and severe pain, as well as the development of adverse drugs reactions (ADR) to NSAIDs 48 weeks after injury. Results. The average intensity of pain during movement decreased from 7.031.66 to 2.211.38 (p0.001), at rest from 4.462.07 to 0.710.989 (p0.001). The number of people with pain severity 4 in the NRS in 48 weeks after the radius fracture, injury of the knee and ligaments of ankle was 21.0, 16.9 and 11.9%, with moderate or severe impairment of the injured limb 40.4, 26.2 and 16.3%, respectively. The need for taking NSAIDs up to 7 days was noted in 43.3%, 714 days-in 41.8%, more than 2 weeks or constantly in 14.9% of patients. Weak or moderate ADR were observed in 20.8% of patients, mainly dyspepsia and hypertension. Discontinuation of NSAIDs due to ADR was required in only 2.6% of patients. Pain retention 4 in NRS was associated with initially expressed pain (7 in NRS) OR 2.75 (95% CI 0.834.13; p0.001) and the presence of osteoarthritis of knee and/or hip OR 1.56 (95% CI 1.032.34; p=0.039). Conclusion. PTP decreases rapidly in most patients after a radius fracture, injury of the knee, and ankle ligament injury while taking the original meloxicam. However, in a significant part of patients, moderate or severe PTP persists after 48 weeks, which requires prolonged analgesic therapy and active rehabilitation.

Janus kinase (JK) inhibitors block the intracellular signaling pathways that are responsible for the synthesis of proinflammatory cytokines and mediators, which in turn cause the activation of pain receptors and central sensitization (CS). It is suggested that JK inhibitors can rapidly eliminate pain and reduce the severity of CS.Objective: to evaluate the effect of the JK inhibitor tofacitinib (TOFA) on the intensity of pain and the signs of CS in patients with active rheumatoid arthritis (RA) at 7 and 28 days after therapy initiation.Patients and methods. A study group consisted of 39 patients (79.5% female) (mean age 50.9±11.1 years) with RA (DAS28 5.8±0.6). Of these, 89.7% were seropositive for rheumatoid factor; 82.0% took methotrexate and 18.0% received leflunomide. All the patients were prescribed TOFA 5 mg twice daily due to the inefficacy or intolerance of biological agents. The investigators estimated pain intensity using a Brief Pain Inventory (BPI), rated the presence of a neuropathic pain component (NPC) with the PainDETECT questionnaire, and assessed the signs of CS with the Central Sensitization Inventory (CSI) during the first 4 weeks after TOFA administration.Results and discussion. The patients initially experienced moderate or severe pain (the mean scores of 5.33±2.51 on the numerical rating scale (NRS) included in BPI); 53.8% had signs of CS (CSI scores of ≥40); 17.9% had signs of a NPC (PainDETECT scores of >18). Already on day 7 after the start of TOFA administration, there was a statistically significant decrease in the mean NRS pain intensity scores to 4.06±2.2 (p=0.01) and by 29.4±17.9%, as shown by the patient's assessment of the analgesic effect of therapy (BPI), as well as the severity of CS, namely a decrease in the mean NRS pain score to 35.9±11.2 (p=0.01). On 28 days, the effect became better: there was a reduction in the level of NRS pain to 2.32±1.57 (p

To identify risk factors for gastrointestinal, cardiovascular, and thrombotic complications, as well as postoperative bleeding, by individually choosing analgesic anti-inflammatory therapy, including that with nonsteroidal anti-inflammatory drugs, is the most important task in the preoperative preparation of patients with rheumatic inflammatory joint diseases.The paper reviews studies evaluating the efficiency and safety of long-term aceclofenac use in patients who are to undergo joint surgery.

Objective: to assess quality-of-life (QoL) dynamics in patients with rheumatoid arthritis (RA) when initiating therapy with biological agents (BAs) in real clinical practice.Patients and methods. The investigation enrolled patients with RA from the patient cohort participating in the TERMINAL-II multicenter Russian study, who newly initiated BA therapy. In the self-assessment terminal, the patient completed HAQ, EQ-5D, and RAPID-3 questionnaires. DAS28, SDAI, CDAI, and RAPID-3 were used to determine disease activity. The patient's functional status and QoL were assessed using the HAQ index and the EQ-5D questionnaire, respectively. The efficiency of the therapy was analyzed 6 months after the start of the study according to the standard procedures.Results and discussion. The investigation enrolled 156 RA patients: 79.6% females; mean age, 45.8±13.2 years; disease duration, 7.6±5.6 years. The patients had high RA activity (a mean DAS28 of 5.2±1.2, a mean SDAI of 39.5±16.4, a mean CDAI of 27.5±10.4, and a mean RAPID-3 of 15.1±3.6) and previous inefficacy of synthetic disease-modifying antirheumatic drugs (DMARDs) after at least 6 months of therapy. Only 1.2% of patients had a good functional status comparable to the population-based control (HAQ 40.5). 70% of patients needed to take non-steroidal anti-inflammatory drugs (NSAIDs). The first BA was chosen in accordance with the recommendations for administration of BAs and in terms of their availability in a specific region of the Russian Federation. The first prescribed BA was tumor necrosis factor-a (TNF-a) inhibitors in 112 (71.8%)patients, anti-B-cell therapy in 14 (9.0%), an interleukin-6 receptor inhibitor in 16 (10.3%), and a leukocyte costimulatory inhibitor in 14 (9.0%). Comparison of the patients receiving newly initiated therapy with TNF-a inhibitors and drugs with other mechanisms of action showed that the patients who had abatacept received higher doses of methotrexate (MTX), but lower doses of glucocorticoids (GCs) than those who were prescribed rituximab and tocilizumab. A statistically significant decrease in DAS28, SDAI, CDAI, and RAPID-3 scores was achieved after 6 months of therapy. Improvements of functional status and QoL in patients were also noted (p

Coexisting hip osteoarthritis (OA) and lumbar spinal stenosis (central and foraminal) and/or spondylolisthesis is called a hip-spine syndrome (HSS). The central problem is correctly diagnosing and determining the tactics of surgical or medical treatment for patients with HSS. The paper describes a clinical case of a female patient with HSS and an examination algorithm for determining the significance of peripheral neuropathy and hip OA and discusses the choice of surgical treatment tactics.

Objective: to describe the portrait of a patient with rheumatoid arthritis (RA) in real clinical practice, to assess disease activity from the point of view of a physician and a patient, functional status, quality of life (QOL), and the efficiency of the therapy performed.Patients and methods. The investigation enrolled 976 RA patients from a cohort of patients in the TERMINAL-I multicenter study, who, when visiting a rheumatologist, independently assessed the disease activity and QOL using a computer system (the «Computer Terminals of SelfAssessment for Patients with Rheumatic Diseases» project). The mean age of the patients was 52.30±13.3 years; women accounted for 85%; the median disease duration 8.0 [4.0; 14.0] years. Baseline clinical parameters and pharmacotherapy were evaluated for 6 months. The disease activity was determined by the DAS28 and RAPID-3 indices; functional status and quality of life were evaluated by the HAQ and the EQ-5D, respectively.Results. 83% of the RA patients were positive for rheumatoid factor and 60% were for anti-cyclic citrullinated peptide antibodies. There was a preponderance of patients with high (40.5%) and moderate (46.8%) RA activity; 6.9% were observed to have a low activity; 5.8% had clinical remission. The mean values of DAS28 and RAPID-3 were 4.7±1.3 and 13.7±3.6, respectively. Only 14.3% of patients had a good functional status that was comparable with the population-based control (HAQ≤0.5). The remaining patients were found to have a substantial decrease in joint functional parameters (median HAQ 1.88 [1.0; 2.5]) and EQ-5D QOL (0.60 [0.60; 0.74). Prosthetic joints were present in 7.4% of patients. At visit 1 to a rheumatologist, the therapy was changed in 15% of patients. During 6-month follow-up, conventional disease-modifying anti-rheumatic drugs were taken by almost all (91.2%) patients. Of them, 70.9% of the patients were treated with methotrexate (MTX): 77.0% received the latter at a dose of 15 mg/week and 23.0% had it at a dose of >15 mg (17.5 to 40 mg/week). Glucocorticoids could be stopped in 20.5% of the patients within six months. Tumor necrosis factor-α inhibitors and anti-B-cell therapy were used in 6.6 and 16.2% of patients, respectively. At 6-month follow-up (Visit 2), 54% of patients achieved a 20% clinical improvement in the ACR criteria. At the same time, the DAS28 scores decreased substantially from 4.5±1.2 to 3.8±1.1 (p = 0.0001). There was a minimal functional improvement in the HAQ index in 64% of patients and a better EQ-D QOL scores in 16%.Conclusion. The majority of RA patients who came to the rheumatologists showed high to moderate disease activity. This was due to long disease duration, inadequate MTX dose, and insufficient patient monitoring in real clinical practice. Introduction of a computer system for selfassessment of their health status by RA patients in an outpatient setting could improve the interaction of physicians, nurses, and patients, better monitor disease activity, and enhance therapeutic efficiency.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a main tool to treat acute nonspecific low back pain (NLBP). However, no factors that influence the efficacy of these drugs have been identified to the present day.Objective: to evaluate the therapeutic effect of and tolerance to NSAIDs (meloxicam) in treating acute NLBS and to identify the factors influencing the efficacy of this drug.Patients and methods. A study group consisted of 2078 patients (mean age 46.3±13.4 years; women 56.6%) with acute NLBS who had been treated in real clinical practice. The level of pain was estimated using a 0–10 point numerical rating scale (NRS). Initially, the pain level averaged 6.69±1.65 scores; 57.0% of patients were noted to have severe pain (≥7 NRS scores). Pain at rest persisted in 32.0% of patients; that at night was in 19.0%; sensation of stiffness in 60.7%, irradiation to the leg in 28.2%, and lumbar ischialgia in 9.6%. 70.2% of patients had been previously treated with NSAIDs for NLBS, while only 28.0% rated their efficacy as good. All the patients were prescribed meloxicam at a dose of 15 mg/day for a period of up to 2 weeks. 86.1% of the patients received meloxicam intramuscular for 2 days, then orally; 13.9% took the drug only orally. 52.3% of the patients also used muscle relaxants; 17.4% received oral or intramuscular B vitamins. The study estimated the rate of complete pain relief when NSAIDs were used for up to 2 weeks.Results and discussion. Complete pain relief was achieved in 75.2% of patients. 83.7% of patients rated the effect of treatment as good or excellent. Undesired drug reactions were recorded in 4.6% of patients. Female gender had no effect on treatment outcome (odds ratio (OR)=0.967; 95% confidence interval (CI), 0.795–1.177; p=0.763). Age over 65 years, the first NLBS episode, and a good NSAID effect in a history were associated with the best treatment result: OR=2.053 (95% CI, 1.5920–2.642), p

Surgical treatment in patients with rheumatic diseases (RDs) is associated with the higher risk of complications due to the presence of the inflammatory process, to long-term therapy with glucocorticoids, disease-modifying antirheumatic drugs, and biologic agents (BA), to decreased physical activity, and the severity of functional disorders, and to obvious osteoporosis. All this increases the risk of intraoperative complications, including periprosthetic fractures.Objective: to comparatively analyze intraoperative periprosthetic fractures of the greater trochanter, acetabulum, and proximal femur during total hip arthroplasty (THA) in patients with RDs.Subjects and methods. From 1998 till 2017, a total of 1569 THA were performed in patients with RA, including 464 patients with rheumatoid arthritis (RA), 396 with juvenile rheumatoid arthritis (JRA) and systemic lupus erythematosus (SLE), and 709 with osteoarthritis (OA).Results and discussion. Periprosthetic fractures after THA were diagnosed in a total of 68 (4.33%) patients, including 23 (4.96%) patients with RA, 27 (6.82%) with JRA and SLE, and 18 (2.54%) with OA; 42 (61.8%) patients with periprosthetic fractures underwent osteosynthesis. Statistical analysis of the findings revealed significantly higher rates of complications in patients with RA and JRA with SLE (p < 0.005).Conclusion. The findings confirm that the risk of periprosthetic fractures is higher in patients with inflammatory diseases, including RA, JRA, and SLE. These patients require a special approach that involves medical correction of impaired bone metabolism and proper individual selection of endoprosthetic components, by taking into account the anatomical features of female patients and delicate bone handling during surgery.

The article presents the guidelines developed by the American College of Rheumatology and the American Association of Hip and Knee Surgeons for the perioperative management of patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis, or systemic lupus erythematosus who are undergoing elective total hip or knee arthroplasty. It considers the perioperative use of antirheumatic drug therapy, including disease-modifying anti-inflammatory drugs, biological agents, tofacitinib, and glucocorticoids. All recommendations are conditional and based on the results of retrospective clinical trials, which should be considered when making decisions about perioperative antirheumatic therapy.

Osteoarthritis (OA) is a progressive joint disease that causes persistent pain, limited joint function, disability, and loss of social activity. One of the most popular OA treatment options is intra-articular (I/A) hyaluronic acid (HA) injections. This procedure was introduced into clinical practice in the early 1980s and is used universally. To date, there is no consensus on the therapeutic value of HA. Many investigations confirm that HA is effective as not only a symptomatic agent, but also a structure-modifying one. Some works also show that the effect of HA is equal or only slightly superior to that of placebo (I/A saline injection). The review describes the mechanism of action and comparative efficacy of various (lowand high-molecular weight) HA preparations, as well as the safety of their use in real clinical practice.

Objective: to assess the reliability, validity, and sensitivity of a Russian version of the LupusQol questionnaire.Subjects and methods. The investigation enrolled 328 patients aged 18 years or older with systemic lupus erythematosus (SLE) who met the 2012 Systemic Lupus International Collaborating Clinic (SLICC) criteria. Two tools, such as the 36-item Short-Form Health Survey (SF-36) questionnaire and LupusQol questionnaire filled out by the patients, were used to study their health-related quality of life (HRQOL). Activity was estimated using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K); irreversible organ damages were evaluated by the SLICC damage index (DI). Reliability evaluation included a study of the reproducibility and internal consistency of the index. Reproducibility was evaluated using the test-retest analysis; the internal consistency was measured by calculating Cronbach’s alpha; the sensitivity was assessed by the changes in the questionnaire domains during standard therapy for SLE. Construct validity was determined in two ways: by using the known-groups method and factor analysis; criterion validity was measured by assessing the relationship with the external criteria (SF-36).Results and discussion. A total of 108 SLE patients were included to assess the reliability of the questionnaire. The results of assessing the reproducibility of the LupusQol questionnaire by the test-retest analysis showed no significant differences between the initial and repeated measures on all 8 LupusQol domains (p > 0.05). The value of Cronbach’s alpha ranged from 0.8 to 0.9 for each of the 8 questionnaire domains. After 12 months of standard therapy, 128 patients included in the assessment of questionnaire sensitivity showed a significant improvement in HRQOL for all questionnaire domains. The most significant positive changes were achieved on the domains of pain (p = 0.002), intimate relationships (IR; p=0.01), body image (p=0.0003), and fatigue (p=0.006).Validity was assessed in 328 patients with SLE. Construct validity was assessed by comparing the domains of the LupusQol and SF-36 questionnaires. A correlation (r > 0.4) was found on all the 8 LupusQol domains: physical functioning (PF), role-physical functioning (RPF), general health (GH), viability (V), social functioning (SF), and role-emotional functioning (REF) of the SF-36 questionnaire. The factor analysis of the LupusQol questionnaire revealed a satisfactory ratio of the distribution of its questions to its domains and a high correlation between the domains and its factor. Criterion validity was evaluated by comparing the LupuQol domains in 4 groups: 1) SLEDAI-2K < 4; 2) SLEDAI-2K ≥4; 3) SLICC DI = 0; 4) SLICC DI ≥1. Significant differences were found between the active SLE (SLEDAI-2K >4) group and inactive SLE (SLEDAI-2K

Nonsteroidal anti-inflammatory drugs (NSAIDs) are an important component of a multimodal pain management program in patients with rheumatic diseases in the perioperative period. NSAIDs have comprehensive analgesic, antiinflammatory, and antipyretic effects associated with blockade of the enzyme cyclooxygenase-2 and suppression of the synthesis of prostaglandins, one of the main mediators of pain and inflammation, which are synthesized in response to surgical tissue injury. NSAIDs can ease the suffering of patients in the pre- and postoperative periods and reduce the need for opioid analgesics and the frequency of adverse events (AE) caused by the latter. The choice of NSAIDs is largely determined by the risk of AE: gastrointestinal, cardiovascular and postoperative bleeding. The paper considers whether different NSAIDs can be chosen for patients with joint diseases during surgical treatment in terms of their efficacy and safety.

Total joint replacement (TJR) in the presence of severe joint degradation and arthralgias in patients with rheumatic diseases (RDs) is one of the effective ways to improve the functional status of patients and their quality of life. In recent years, there has been an increase in the number of such knee and hip replacements worldwide. Despite advances in medicine in the 21st century, up to 5% of TJRs culminate in early complications, in which there are irreversible joint changes that cause joint functional loss and persistent pain and, in 2–3% of cases, require early re-revision surgery.Subjects and methods. The investigation included 2142 patients with rheumatoid arthritis (RA) and osteoarthritis (OA) who underwent knee or hip joint replacement (KJR or HJR) at the V.A. Nasonova Research Institute of Rheumatology during the period 1998 to 2016: HJR in 1177 patients and KJR in 965. The patients with RA had 467 HJRs and 651 KJRs (a total of 1118 operations). A comparison group consisted of patients with OA who underwent710 HJRs and 314 KJRs (a total of 1024 operations). Postoperative surgical complications, such as superficial or deep suppuration, joint dislocation, periprosthetic fractures, sciatic and/or peroneal neuropathies, aseptic instability of endoprosthesis components, and complications of wound and ligamentous apparatus, were considered within 2 years after surgeryResults and discussion. Overall, the frequency of local complications after HJR and KJR was comparable and amounted to 7.22 and 7.25%, respectively (p=0.83), but their pattern greatly differed: there were a larger number of periprosthetic fractures after HJR than after KJR (3.48% and 0.93%; p

Objective: to assess the psychometric properties of EQ-5D and RAPID-3 indices in patients with panniculitis (PN). Subjects and methods. A total of 83 patients (80 women, 3 men) diagnosed with PN, followed up at the V.A. Nasonova Research Institute of Rheumatology in 2013–2015 were examined. The patients’ mean age was 43.4±13.9 years; median disease duration was 5 [2; 24] months. All the patients filled out the EQ-5D and RAPID-3 questionnaires during the first visit and 12 months later. The sensitivity of the questionnaires was assessed by comparing the index scores with the treatment response that was estimated by the achievement of nodular regression at the time of a follow-up examination. The construct validity was determined using a correlation analysis with external criteria. Results and discussion. Positive clinical changes (achievement of nodular regression) were correlated with improvement in EQ-5D and RAPID-3 scores. The median posttreatment change in EQ-5D index scores was 0.27 [0.12; 0.45] (p=0.005), and after treatment the RAPID-3 scores decreased by an average of 9.2±5.2 (p=0.0011). Assessing the validity of EQ-5D index scores in patients with PN revealed moderate correlations not only with clinical (nodular tenderness on palpation, as evaluated by a visual analogue scale, but also with laboratory (erythrocyte sedimentation rate, C-reactive protein levels) parameters. The RAPID-3 function assessment index correlated with the clinical signs of PN. Conclusion. The EQ-5D and RAPID-3 questionnaires are valid and sensitive common instruments for assessing quality of life and functional status in patients with PN.

Authors report new recommendations of All-Russian Public Organization «Association of Rheumatologists of Russia» (ARR) on treatment of rheumatoid arthritis (RA), which adapts contemporary concept accepted in the respective field of pharmacotherapy known as «Treat to Target». According to it, the main objective of RA pharmacotherapyis a remission (or low disease activity). To achieve it, disease modifying anti-rheumatic drugs (DMARD) should be administered to all RA patients as early as possible, with efficacy monitoring and therapy correction according to the disease activity. Special attention has been paid to the use of methotrexate (MTX) as «the gold standard» of RA pharmacotherapy and the key component of «Treat to Target» strategy. Early MTX administration (including subcutaneous injections) should become an obligatory component of RA treatment at all stages of the disease. If MTX is not efficient or not well tolerated (including subcutaneous form of the drug) as monotherapy or combined with conventional DMARD, biological agents should be used. Those include TNFα inhibitors, antagonist of interleukin-6 receptor (Tocilizumab), anti-B-cell drugs Rituximab) and agents blocking T-cell activation (Abatacept). Tofacitinib therapy (JAK inhibitor) is indicated in patients who are resistant to conventional DMARDs and biologics. All biologics and Tofacitinib are more effective in combination with MTX (or other DMARD).

The Foot Functional Index (FFI) questionnaire most completely reflects the functional status of patients with joint diseases of the feet.Objective: to study the psychometric properties of a Russian-language version of the FFI questionnaire.Patients and methods. The reliability, sensitivity, and validity of the Russian-language version of the FFI questionnaire were assessed in 55 patients with rheumatoid arthritis (RA). The investigators checked the reliability by assessing the internal consistency (calculating Cronbach's alpha) and reproducibility by a test-retest analysis. The criterion validity was evaluated by correlation analysis using HAQ, RAPID3, and pain visual analogue scale (VAS) scores. The sensitivity of FFI was studied by comparing its dynamics with RAPID3 changes during treatment.Results. Evaluating the internal consistency yielded a high Cronbach's alpha (0.78). The test-retest analysis demonstrated a significant correlation (0.83) between the results of primary and secondary testing. Assessing the criterion validity showed a high or near-high relationship to the scores of RAPID3 (0.78), HAQ (0.69), and pain VAS (0.76). The group of patients who were observed to have a decrease in disease activity according to RAPID3 from a high (16.2±4.1) to moderate (10.5±5.2) degree displayed a more marked reduction in FFI (ΔFFI = 20.5±2.3) than the group that did not exhibit significant changes in disease activity (ΔFFI = 6.9±3.4).Conclusion. FFI is a reliable, valid, and sensitive tool to evaluate the functional status of patients with foot diseases in RA.

One of the most menacing complications of large joint total endoprosthesis (TE) in patients with rheumatic diseases (RD) is the development of periprosthetic infection (PI), progression of which may give rise not only to limb loss, but also death. At the same time, early diagnosis and adequate surgical care make it possible not only to arrest the infectious process, but also to preserve an implanted joint.Objective: to define criteria for the diagnosis, prevention, and treatment of PI after hip and knee joint (HJ and KJ) TE in patients with RD.Subjects and methods. In 2009 to 2013, 654 KJ and 549 HJ TE was performed in the V.A. Nasonova Research Instituteof Rheumatology performed KJ (n = 654) and HJ (n = 549) joint ERs.Results and discussion. PI developed in 12 (3.63%) and 8 (2.95%) patients after KJ and HJ ER, respectively. Early, delayed, and late PI was seen in 11, 6, and 3 patients, respectively. Eleven patients with early PI underwent joint revision/ debridement with preservation of an endoprosthesis and replacement of HJ endoprosthetic inserts and heads. The operations were completed with the collagen hemobiotics being left in the wound and its drainage. Systemic antibiotic therapy was used for 4–6 weeks. No recurrent infection was observed in 9 cases. Two patients underwentresurgery, by setting suction-irrigation systems. Nine patients with delayed or late PI had the following operations: A single-stage revision operation (the endoprosthesis was removed and a new one was implanted) was performed in two cases of stable endoprosthetic components and accurately verified low-virulent microorganisms susceptible to certain antibiotics. It was imperative to use cement with an antibiotic, collagen hemobiotics, and systemic antibiotic therapy for 6 weeks. The other 7 patients with unstable endoprosthetic components underwent two-stage revision: Stage 1, endoprosthetic removal and antibiotic-loaded spacer implantation; 6-12 weeks after postoperative wound healing, 6 patients underwent Stage 2, removal of the spacer and implantation of a new endoprosthesis. Following Stage 1, one female patient developed generalized infection and, because of her advanced age and comorbidities, underwent amputation followed by exoprosthetic replacement.Conclusion. The practical application of the current diagnostic criteria allowed to reveal early slowly progressive PI, perform early surgical treatment without endoprosthetic removal in 11 patients, and prevent recurrent infection in 81.8% of the patients. The described treatment policy for PI turned out to be effective and prevented recurrent infection in 70% of the patients during 1 to 5 years.

Authors report new recommendations of All-Russian Public Organization «Association of Rheumatologists of Russia» (ARR) on treatment of rheumatoid arthritis (RA), which adapts contemporary concept accepted in the respective field of pharmacotherapy known as «Treat to Target». According to it, the main objective of RA pharmacotherapy is a remission (or low disease activity). To achieve it, disease modifying anti-rheumatic drugs (DMARD) should be administered to all RA patients as early as possible, with efficacy monitoring and therapy correction according to the disease activity. Special attention has been paid to the use of methotrexate (MTX) as «the gold standard» of RA pharmacotherapy and the key component of «Treat to Target» strategy. Early MTX administration (including subcutaneous injections) should become an obligatory component of RA treatment at all stages of the disease. If MTX is not efficient or not well tolerated (including subcutaneous form of the drug) as monotherapy or combined with conventional DMARD, biological agents should be used. Those include TNFα inhibitors, antagonist of interleukin-6 receptor (Tocilizumab), anti-B-cell drugs (Rituximab) and agents blocking T-cell activation (Abatacept). Tofacitinib therapy (JAK inhibitor) is indicated in patients who are resistant to conventional DMARDs and biologics. All biologics and Tofacitinib are more effective in combination with MTX (or other DMARD).

Prolonged hip arthritis in juvenile arthritis (JA) is a cause of serious joint destruction, leading to severe pain and functional disorders.Objective: to assess the results of total hip arthroplasty (THA) in patients with JA. Subjects and methods. The investigation enrolled 20 women and 2 men. Their mean age at the time of surgery was 27.9 (18–49) years, mean weight – 47.7±2 kg. Mean height was 155.1 cm, which confirms growth retardation in these patients. The disease duration averaged 7.1 years. Mild protrusion of the acetabulum was stated in 9 (41%) and 13 (59%) patients, respectively.Results and discussion. Functional status was assessed with Harris hip score (HHS), and Health Assessment Questionnaire (HAQ), pain – with visual analogue scale (VAS) quality of life (QL) – with EQ-5D before and 6–12 months after surgery. Six months after surgery, the mean EQ-5D score increased from 0.13 to 0.47 (ΔEQ-5D = 0.34;р< 0.05), which corresponded to a moderate clinical response in QL. Only after 12 months of follow-up, there was a pronounced effect of surgical treatment: the EQ-5D index increased up to 0.64 (ΔEQ-5D = 0.51; p< 0.05). On the average, HAQ decreased from 2.016 to 1.429 after 6 months and to 1.159 after 12 months, which was suggestive of a significant clinical improvement. Functional status also improved according to HHS: at 6 months, it was assessed as good (HHS, 80-89) in 3 (13.6%) patients; satisfactory – in 9 (40.9%), and 10 (45.5%) patients had HHS below 70; at 12 months, it was excellent (HHS, 90–100) in 4 (18.2%), good (80–89) – in 4 (18.2%), satisfactory – in 8 (36.4%) and 6 (27.2%) patients had HHS lower than 70. Preoperatively, pain on VAS averaged 65.4 mm; 6 and 12 months following surgery, it reduced to 41.6 and 36.3 mm, respectively. Conclusion. THA in patients with JA significantly improves the function of the affected hip joint and QL. It is also important to note that THA promotes social adaptation – three patients have entered higher educational establishments and two more patients have got married and given birth to healthy babies.

Endoprosthetic replacement is a widely used treatment for joint disease worldwide. In the past few decades, the rate of endoprosthetic replacement of different joints has substantially increased – about 1.5 million operations yearly. The paper considers the problems of endoprosthetic joint replacement in patients with rheumatoid arthritis (RA) receiving biological agents (BAs). The latter are extensively used to treat not only the early, but also late stages of the disease when there are already indications for endoprosthetic joint replacement, but the activity of the disease cannot be diminished by standard therapy with disease-modifying antirheumatic drugs. BA therapy can enhance the efficiency of monitoring the activity of RA in its different stages and improve functional parameters. There is an increase in the number of patients requiring endoprosthetic joint replacement and receiving BAs. Data on the safety of BAs used in the perioperative period are given. Endoprosthestic joint replacement during this therapy makes it possible to decrease the degree of pain syndrome, to improve the function of an operated joint and the quality of life in patients, to affect the course of RA, to lower disease activity, and to improve their monitoring.

Authors report new recommendations of All-Russian Public Organization «Association of Rheumatologists of Russia» (ARR) on treatment of rheumatoid arthritis (RA), which adapts contemporary concept accepted in the respective field of pharmacotherapy known as «Treat to Target». According to it, the main objective of RA pharmacotherapy is a remission (or low disease activity). To achieve it, disease modifying anti-rheumatic drugs (DMARD) should be administered to all RA patients as early as possible, with efficacy monitoring and therapy correction according to the disease activity. Special attention has been paid to the use of methotrexate (MTX) as«the gold standard» of RA pharmacotherapy and the key component of «Treat to Target» strategy. Early MTX administration (including subcutaneous injections) should become an obligatory component of RA treatment at all stages of the disease. If MTX is not efficient or not well tolerated (including subcutaneous form of the drug) as monotherapy or combined with conventional DMARD, biological agents should be used. Those include TNFα inhibitors, antagonist of interleukin-6 receptor (Tocilizumab), anti-B-cell drugs (Rituximab) and agents blocking T-cell activation (Abatacept). Tofacitinib therapy (JAK inhibitor) is indicated in patients who are resistant to conventional DMARDs and biologics. All biologics and Tofacitinib are more effective in combination with MTX (or other DMARD).

The paper considers the joint management of rheumatoid arthritis patients needing endoprosthetic replacement of the large joints of the lower extremities by rheumatologists and orthopedic traumatologists.Due to the fact that there are no conventional standards or guidelines for the perioperative management of patients with rheumatic diseases, adopted by international rheumatology associations, the authors generalize their experience in managing the patients in terms of international approaches and guidelines from different countries. The medical assessment and reduction of cardiovascular risks, the prevention of infectious complications, hemorrhages, and lower extremity deep vein thrombosis, and the specific features of management of patients with osteoporosis are under consideration. The authors' experience in managing the patients receiving antirheumatic therapy with nonsteroidal antiinflammatory and disease-modifying antirheumatic drugs, such as methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine, is detailed. Recommendations for managing patients taking glucocorticoids and biologic agents (tumor necrosis factor-α inhibitors, anti-B-cell therapy, and interleukin-6 receptor inhibitors) in the preoperative andpostoperative periods are given.

The paper reviews data on the incidence of rheumatoid arthritis, disability, and the cost of treatment, including thera- py with biological agents.

Objective: to analyze disease activity, functional state, quality of life (QL), and the frequency of infectious complications in methotrexate (MT) – or leflunomide (LF)-treated patients with rheumatoid arthritis (RA) who had undergone endoprosthetic replacement of the large joints of the lower limbs. Subjects and methods. One hundred and fourteen patients with RA who had undergone endoprosthetic replacement of the knee and hip joints were divided into 3 groups: 1) 36 patients who continuously received MT or LF in the perioperative period; 2) 42 patients who dis- continued MT or LF 2 and 4 weeks, respectively, prior to surgery; 3) 36 patients who took no disease-modifying anti-rheumatic drugs (DMARDs) within 12 months before surgery. Disease activity was estimated by the DAS28 index. QL was determined using the EQ-5D questionnaire and functional capacity was estimated by the HAQ index. Results and discussion. In all the groups, there was a preponderance of patients with moderate RA activity (more than 60%). In Groups 1 and 2, the mean dose of MT was about 10 mg weekly and that of LF was 20 mg daily. The use duration of glucocorticoids (GC) and their doses were comparable in all the groups. Twelve months after surgery, DAS28 significantly reduced from 4.22±1.08 to 3.58±1.07 months in Group 1 (p = 0.01); in Group 2, the decrease was insignificant: from 4.17±1.17 to 3.80±1.15 (p > 005); in Group 3, RA activity remained as before. All the groups achieved 50% functional improvement; better results were obtained in the group of patients who continued to use DMARDs in the perioperative period (∆HAQ=-0.67). The difference in the Eq-5D index corresponded to a moderate QL improvement: ∆EQ-5D = 0.28, 0.29, and 0.31 in Groups 1, 2, and 3, respectively (p < 0.05). There were no significant group differences. Deep infection in the endoprosthetic replacement area was detected in 2.8, 2.4, and 8.3% of cases, respectively (p > 005). Conclusion. Continuous use of MT and LF leads to a reduction in total disease activity and to functional improvement in patients with RA after endoprosthetic joint replacement, without increasing the frequency of infectious complications.

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.