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BACKGROUND: In recent years, in traumatology and orthopedics, statistical methods of survival analysis have been used to assess long-term treatment results, which make it possible to take into account censored clinical observations. This method of statistical analysis allows to take into account both cases of attrition from care and cases of incomplete follow-ups. There is no concurrent point of view on the dependence of the long-term results of hip and knee arthroplasty on the comorbidity of a patient. This circumstance fosters a special study using survival analysis. AIM: To study the long-term results of total hip and knee arthroplasty in the patients with osteoarthritis. To determine the patients quality of life depending on the presence of pronounced concomitant pathology. MATERIALS AND METHODS: The groups of patients with comorbidity and without significant concomitant pathology have been compared. The first group included 806 patients aged 19 to 88 years who underwent primary total hip replacement in the Clinic of Traumatology and Orthopedics of the North-Western State Medical University named after I.I. Mechnikov from 2014 to 2018 in connection with osteoarthritis. The second group consisted of 376 patients aged 43 to 85 years who underwent primary total KR due to osteoarthritis in the V.A. Baranov Republican Hospital (Petrozavodsk) in 20162019. Statistical data processing and graph design have been carried out with R programming language with open access via https://cran.r-project.org. The probability of maintaining a satisfactory assessment of the quality of life by a certain observation point t (year of observation) has been assessed using the KaplanMayer method. The logrank test has been used in order to compare the probability of maintaining a satisfactory assessment of quality of life during the entire follow-up period in the groups of patients with and without polymorbidity. RESULTS: At the end of the 5th year of follow-up, the probability of maintaining excellent and good quality of life after hip replacement with a 95% confidence interval was 0.88 (0.81; 0.94) in the patients without comorbidity, 0.84 (0.79; 0.88) in the patients with severe concomitant pathology. Test statistics (Z = 0.93) and p = 0.31 indicate statistically insignificant differences in survival curves between the groups of patients with varying degrees of comorbidity. When analyzing the five-year results of the knee replacement, the quality of life among patients with high and low comorbidity did not differ significantly. The probability of excellent and good quality of life at the 5th year of follow-up in practically healthy patients and in cases of mild therapeutic disease was 0.78 (0.67; 0.88); with a high degree of comorbidity 0.74 (0.65; 0.81). CONCLUSIONS: By the end of the 5th year of follow-up of the patients who have undergone hip or knee replacement due to osteoarthritis, an excellent and good quality of life can be expected on average in 80% of the patients. Satisfactory and unsatisfactory in 20% of the patients. Excellent and good quality of life 5 years after hip or knee arthroplasty in the patients with severe comorbidity does not significantly differ from that in the practically healthy patients without comorbidity (р 0,05).

Osteoarthritis has the highest prevalence among the musculoskeletal diseases in all economically developed countries. Despite the improvement of diagnostic and treatment methods, the number of patients with osteoarthritis is increasing. The number of cases of newly diagnosed osteoarthritis, cases of disease progression and subsequent disability are also growing. There are many guidelines for treatment of osteoarthritis, however, specialists have no consensus, especially regarding the amount and duration of conservative therapy. The aim of the study was to analyze publications providing complex treatment options of hip osteoarthritis. A systematic literature review has been conducted by means of the open acccess Pub-Med/MEDLINE database and eLibrary search for the period until January 2022. The search depth was 20 years and was performed by keywords and phrases: hip joint osteoarthritis, conservative treatment, minimally invasive surgery, total hip arthroplasty. Unfortunately, the screening criteria for patients with osteoarthritis for total hip arthroplasty are not developed. The review analyzes the options of conservative therapy and minimally invasive surgical treatment for patients with osteoarthritis as the opportunity to avoid or delay the total hip replacement. The hip arthroplasty is not considered the gold standard; joint decision on surgery based on a comprehensive approach is made only when all the possibilities of conservative therapy are exhausted. It is widely believed that complex treatment using modern conservative and organ-preserving methods is the most common strategy for managing osteoarthritis of the hip joint. This approach improves clinical and functional condition of patients and slows down the progression of the disease.

BACKGROUND: Osteoarthritis is a disease highly associated with a wide range of comorbidities, which leads to significant limitations of the therapeutic possibilities, in particular, the long-term use of non-steroidal anti-inflammatory drugs. Thus, develop algorithms for effective treatment of osteoarthritis aimed at reducing the need for anti-inflammatory therapy is of great importance. AIM: To evaluate the efficacy and safety of hyaluronic acid for the treatment of osteoarthritis in patients with comorbid pathology. MATERIALS AND METHODS: 30 patients aged 40 to 65 years with IIIII stages of knee osteoarthritis who received treatment with the hyaluronate sodium were examined according to the KellgrenLawrence scale. The course of treatment included standard intra-articular injections of Revisk (sterile sodium hyaluronate gel obtained by microbial fermentation) into the knee joints once a week, in a course of 3 injections. During the study non-steroidal anti-inflammatory drugs therapy was allowed at stable standard dosages. The effectiveness of treatment was assessed by changes in the WOMAC index, the Visual Analog scale pain scores for pain on movement, at rest, goniometry data, 30-meters walking test and stair climb test. RESULTS: A positive effect of treatment on all the parameters has been noted: significant improvement in clinical indicators of pain according to the visual analog scale, functional tests, and the WOMAC index scores. The positive dynamics of the estimated parameters during treatment started from the 7th day of therapy. CONCLUSIONS: The hyaluronate sodium (Revisk) can be used for treating patients with IIIII stages of knee osteoarthritis with moderate dysfunction of joints.

Disseminated seronegative echinococcosis, occurring with damage to soft tissues, bones and joints, is a rare variant of the course of helminthiasis, often associated with diagnostic difficulties, a high probability of complications and difficult treatment. This article presents a case of disseminated seronegative echinococcosis, clinically and laboratory simulating a severe form of WeberChristian panniculitis complicated by sepsis. The advantages and disadvantages of serological and morphological studies in the verification of disseminated echinococcosis are discussed, as well as the feasibility of using repeated histological studies in cases of echinococcosis under the masks of rheumatic diseases.

BACKGROUND: Decreasing new coronavirus infection-associated morbidity and mortality among patients with rheumatic diseases is one of the main goals of current rheumatology. Vaccination may be one of the ways to limit the incidence of new coronavirus infection in patients with rheumatic diseases. AIM: To evaluate the results of vaccination in the patients with rheumatic diseases against the new coronavirus infection according to the data from real clinical practice and a review of the literature. MATERIALS AND METHODS: 68 out of 556 literary medical sources and data from the St. Petersburg register of patients with rheumatic diseases as of September 1, 2021 (n = 16,263) have been analyzed. The data from the register have been compared with the population data on morbidity and mortality from a new coronavirus infection (data of the Ministry of Health of the Russian Federation). RESULTS: Despite the matched incidence rates of new coronavirus infection associated mortality and morbidity in rheumatological patients and population (morbidity 26.2 and 34.1% mortality 3.47 and 2.8%, respectively), the patients with rheumatic diseases demonstrate three times lower frequency of vaccination against new coronavirus infection (13.2% of patients versus 31.8% in the population, respectively). Vaccination is prescribed by rheumatologists in 8.2%; 75% of patients are self-vaccinated. Data analysis from 2,134 rheumatological patients vaccinated in 2021 have shown a decrease in the incidence of the new coronavirus infection to 0.25% compared to the incidence of unvaccinated patients (25.6%) in the absence of deaths among the vaccinated. There were no serious adverse reactions to vaccination among the vaccinated rheumatological patients; in 12% of the cases, pyrogenic post-vaccination reactions, arthralgias and myalgias have been noted. A prolonged pyrogenic reaction, myalgia, arthralgia, hypercreatinophosphataemia have been revealed in 11 patients, who recovered within 6 months. Exacerbations of the underlying rheumatic disease after vaccination has been revealed in 12% of the cases, all the exacerbations have been resolved with the use of standard tactics recommended by the Association of Russian Rheumatologists. The question of the timing and the necessity of revaccination, as well as the long-term efficacy and safety of vaccination, has not yet been resolved. Determining the level of antibodies to coronavirus infection can be a useful option in the formation of an individual vaccination plan for rheumatological patients in the present conditions. CONCLUSIONS: The register data show the efficacy and safety of vaccination against COVID-19 in rheumatological patients in the short term, including in relation to exacerbation of rheumatic disease, and justify the need to comply with epidemiological safety measures after vaccination.

According to modern ideas, the treatment of osteoarthritis should be comprehensive and include a combination of non-drug methods. In addition, routing patients for non-pharmacological treatment is a difficult problem. In addition, doctors of all specialties who, to a greater or lesser extent, are engaged in the treatment of osteoarthritis (therapists, surgeons, rheumatologists, neurologists) widely use local forms of glucocorticoids in the treatment of osteoarthritis. At the same time, many doctors are guided by outdated recommendations for the management of patients with osteoarthritis. Such a monodisciplinarian approach in the treatment of osteoarthritis of the knee joint, coupled with the patient's routing defects, has a number of significant drawbacks, namely, the lack of timely and adequate therapy of the disease based on a convincing evidence base, which ultimately leads to the progression of joint damage, the development of persistent health disorders and limitations of the patient's vital activity. We have analyzed domestic and foreign literature to identify the shortcomings of osteoarthritis treatment, as well as to understand what concepts need to be changed in the structure of the organization of treatment of osteoarthritis of the knee joint. Among the shortcomings of the existing system of care for patients with osteoarthritis of the knee joint, it should be noted the almost complete absence of dispensary monitoring of patients with pathology of the musculoskeletal system in outpatient clinics. In modern conditions of a market economy, an important aspect of the activities of healthcare institutions is the cost of a particular type of treatment, since the heads of medical institutions are forced to think about financing the organization. This situation leads to the fact that inpatient conservative treatment of osteoarthritis of the knee joint in therapeutic departments is unprofitable for a medical institution due to cheap CHI rates. On an outpatient appointment, doctors do not in all cases manage to reliably establish a diagnosis and make a plan for further treatment of the patient. The lack of continuity in the diagnosis and treatment of osteoarthritis of the knee joint leads to a high frequency of the establishment of the disease at late stages, untimely treatment and the development of pronounced persistent structural and functional disorders of the joints, which can only be compensated by radical surgical methods of treatment. On the other hand, primary care physicians (therapists and surgeons) have limited time to receive a patient, which does not allow for a full physical examination necessary for differential diagnosis of joint syndrome, especially considering that most patients with osteoarthritis have concomitant pathology that also requires attention. It should be noted that the shortcomings in the organization of treatment of patients with osteoarthritis of the knee joint are characteristic not only for the Russian Federation, but also for other European countries and the USA. In foreign countries, osteoarthritis is mainly treated in primary health care institutions, and the main role in this case belongs to the therapist (general practitioner). Thus, it can be stated that today the system of organization of treatment of osteoarthritis of the knee joint is imperfect. Outpatient orthopedic care is provided mainly by non-core specialists.

The review presents the results of scientific studies devoted to the features of the course and outcomes of a new coronavirus infection COVID-19 in patients with immuno-inflammatory rheumatic diseases (IIRD). It was noted that the risk of developing COVID-19 for patients with IVR, apparently, is similar to the population or slightly increased and mostly depends on the presence of established risk factors for its severe course (old age, obesity, diabetes mellitus, cardiovascular diseases). Patients receiving long-term immunosuppressive therapy and high doses of glucocorticoids may have a long period of positive viral replication and isolation of a viable virus, which requires dynamic monitoring of such patients and correction of anti-rheumatic therapy. The issues of post-COVID-19 joint syndrome, which can occur within the framework of post-viral arthritis or be the debut of an immuno-inflammatory rheumatic disease, are highlighted. The draft recommendations of the All-Russian Public Organization Association of Rheumatologists of Russia on the management and temporary recommendations of V.A. Nasonova Research Institute of Rheumatology for vaccination of patients with rheumatic diseases in the conditions of the COVID-19 pandemic are presented.

INTRODUCTION: Immune checkpoint inhibitors (ICIs) have significantly improved the prognosis and clinical outcomes for patients with malignancies in many types of cancer. Nivolumab is a human monoclonal antibody that blocks the interaction between PD-1 and PD-L1/2, thereby preventing inhibition of T-cells, which contributes to the antitumor response. The use of ICT can lead to autoimmune aggression and the development of adverse events. Most of these are eliminated on their own after ICT therapy and steroid treatment have been discontinued. CLINICAL CASE DESCRIPTION: A 73-year-old patient with recurrent large B-cell lymphoma, on the background of R-CHOP, R-CHOP-mini, R-GDOx therapy incomplete clinical effect and frequent relapses have been registered. On immunohistochemistry, PD-L1 was positive in 90 % of the tumor cells. A decision has been made to administer the checkpoint inhibitor (PD-1) nivolumab, which developed a necrotizing vasculitis after three injections. CONCLUSION: On temporary withdrawal of the drug and administration of prednisolone at a dose of 1 mg/kg/day, the skin has recovered completely. When the PD-1 inhibitor was reapplied, there was no recurrence of autoimmune aggression. The treatment has been continued in the full way.

Upadacitinib (UPA), a JAK inhibitor, is a new therapeutic option that allows patients with insufficient response to therapy with basic anti-inflammatory drugs (DMARDs) or genetically engineered biological drugs (GEBDs) to achieve the goals of therapy for rheumatoid arthritis (RA). Despite the availability of convincing data from international randomized clinical trials, there is insufficient information about the efficacy and safety profile of UPA, the quality of life of patients receiving the drug in real clinical practice.Aim of the study – to assess the efficacy and tolerability of the UPA drug at a dose of 15 mg/day in patients with rheumatoid arthritis with moderate and high disease activity and to assess their quality of life in real clinical practice.Materials and methods. The study included 41 patients with RA with insufficient effect of previous therapy with DMARDs or GEBDs, persisting moderate or high disease activity, who were initiated with UPA therapy in 7 rheumatological centers of the Russian Federation. To assess the activity of the disease, standard indices were used: DAS28- ESR, DAS28-CRP, SDAI, CDAI. Functional ability was assessed according to the HAQ questionnaire, quality of life – according to the EQ-5D questionnaire, the activity of the disease according to the patient’s opinion – according to the RAPID-3 index. The HADS scale was used to identify the states of depression, anxiety and emotional disorder.Results. During the first week of taking the drug, there was a marked decrease in pain from 60 to 30 mm on a visual analogue scale, which lasted until the third month of therapy. There was a statistically significant decrease in morning stiffness, the number of painful and swollen joints, health assessments by the doctor and patient, erythrocyte sedimentation rate and C-reactive protein (p≤0.001). A decrease in disease activity was also noted according to the dynamics of the activity indices DAS28, SDAI, CDAI (pConclusions. The first results of the use of UPA in RA patients with insufficient efficacy of previous therapy with DMARDs or GEBDs in real clinical practice indicate its efficacy and safety, an improvement in the functional state and quality of life of patients by the 12th week of the study.

The high prevalence and variability of neurological and psychiatric symptoms in systemic lupus erythematosus has become the basis for emphasizing the special neuropsychiatric form of the disorder. Affective disorders (pathological changes in mood and anxiety) are the second most common neuropsychiatric manifestations in patients with systemic lupus erythematosus. However, the current nomenclature primarily focuses on the general clinical manifestations of affective disorders in neuropsychiatric form systemic lupus erythematosus, without evaluating the problems of their etiopathogenesis. Thereby, the aim of this review is the integration of information on the pathological mechanisms of depression and anxiety in patients with systemic lupus erythematosus. The available data on the biological aspects of the anxiety and depression in systemic lupus erythematosus indicate that the complex pathological models may be the best approach for studying, diagnosing, and treating comorbid pathology. The latter can be based on expanding the existing clinical categories, supplementing them with data on pathological mechanisms specific to particular sub-cohorts of patients. Such an approach can provide the specific and most effective preventive, diagnostic and therapeutic measures for each category of patients.

BACKGROUND: The COVID-19 pandemic poses a particular threat to patients suffering from immunoinflammatory rheumatic diseases. New coronavirus infection has been found to be accompanied by the development of a wide range of extrapulmonary clinical and laboratory manifestations, which are characteristic of a number of immunoinflammatory rheumatic diseases. AIM: To evaluate the features of the clinical course of immunoinflammatory rheumatic diseases in patients who underwent new coronavirus infection. MATERIALS AND METHODS: The clinical course of immunoinflammatory rheumatic diseases was analyzed in 324 patients who underwent new coronavirus infection from March 2020 to February 2021 and were treated at the Clinical Rheumatology Hospital No. 25, Saint Petersburg, for exacerbation of the underlying disease. RESULTS: Analysis showed that the risk factors for severe new coronavirus infection in patients with immunoinflammatory rheumatic diseases were: age over 60, comorbidities, use of prednisolone in a dose greater than 12,5 mg, and ESR values 40 mm/hour before the development of new coronavirus infection. There was no effect of immunosuppressive and biological therapy on the severity of the course of viral infection. There was no effect of immunosuppressive therapy and biological therapy on the severity of the course of viral infection in patients with immunoinflammatory rheumatic diseases. The development of the postinfectious syndrome was observed in 1/4 of patients, which was characterized by the formation of postinfectious arthritis in 3,6% of patients, transformation of undifferentiated arthritis into various rheumatic diseases in 49% of patients (more often into early rheumatoid arthritis), as well as exacerbation of the underlying disease in 83,4% of patients with an advanced stage of rheumatoid arthritis. In patients with mixed connective tissue disease, there was a significant increase in immunologic activity due to antinuclear factor (up to a maximum of 1:163 840). Clinical cases of the development of arthritis associated with viral infection and the debut of rheumatoid arthritis after an new coronavirus infection are presented. CONCLUSIONS: New coronavirus infection in the cohort of patients with immunoinflammatory rheumatic diseases observed in the Clinical Rheumatology Hospital No. 25, Saint Petersburg, proceeded in the variant of medium severity in half of patients, initiated the development of lung lesions in 68,6% of patients, arthritis associated with viral infection in 3,6% of patients, immunoinflammatory rheumatic diseases which transformed from undifferentiated arthritis in 49% of cases and exacerbation of the main disease in an overwhelming number of patients. Patients with immunoinflammatory rheumatic diseases have a high risk of adverse outcome of new coronavirus infection, especially in cases of unstable course of the disease or exacerbation of this group of diseases.

In mid-2021, the SARS-CoV-2 (Severe Acute Respiratory coronavirus 2) infection, which caused the coronavirus disease (COVID-19) pandemic, affected more than 157 million people in all regions of the world and led to more than 3.2 million deaths. It is assumed that elderly age, uncontrolled inflammation, anti-inflammatory therapy, comorbid pathology, genetic and other factors can potentially lead to an increase in “sensitivity” to viral and bacterial infections, including SARS-CoV-2. The new version of the recommendations of the Association of Rheumatologists of Russia formulates the main provisions concerning the tactics of managing patients with Immune-mediated Rheumatic Diseases during the ongoing COVID-19 pandemic.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is often complicated by cytokine storm syndrome. Although many interleukins (IL) have predictive value, the sensitivity and specificity of a single marker is limited. AIM: The purpose of the study is to develop an objective and informative cytokine storm scale for assessing the risk of developing a critical course in patients with COVID-19 associated pneumonia. MATERIALS AND METHODS: A total of 226 cases of COVID-19 were investigated, 36 (16 %) of which were with poor outcomes. The cytokines IL-1b, IL-2, IL-6, IL-8, IL-10, IL-18, TNF-, IFN, IFN- were studied by enzyme immunoassay, commercial kits manufactured by Vector-Best, RF. RESULTS: Since IL-6, IL-10, IL-18, and procalcitonin were associated with disease severity and death, these indicators were integrated into a 12-point scale called the cytokine storm scale. The patients who scored more than 6 points had a high risk of a poor outcome of the disease. According to ROC analysis, the area under the curve for the cytokine storm scale was larger than for each of the four markers separately [AUC 0.90 (95% CI 0.84550.9592), p 0.001]. CONCLUSIONS: Thus, the cytokine storm scale system presents superior performance in determining patients with favorable and fatal outcomes to each individual cytokine.

The purpose of this study was to determine the profile of immunoreactants deposited in intact skin biopsies from the patients with confirmed and probable systemic lupus erythematosus. The study involved 94 patients who, along with a standard clinical and laboratory examination, underwent a biopsy of clinically healthy skin in the deltoid muscle area (lupus band test). The nature and combination of immune deposits in the skin, the strength of immunofluorescence, and the location were evaluated. In the patients with significant systemic lupus erythematosus (n = 56), lupus band test was positive in 60.7 % of the cases and correlated with disease activity according to SLEDAI 2K (p = 0.001). At the same time, the skin biopsy often revealed the immunoreactant IgM (85.3 %), the degree of fluorescence of which had direct correlations with the increased level of antibodies to dsDNA (p 0.05). In the examined patients with probable systemic lupus erythematosus, positive lupus band test was detected in 47 % of cases, and IgM was detected in 72.2% of patients, which brought them closer to the group of patients with confirmed systemic lupus erythematosus. However, 33.3% of patients with probable systemic lupus erythematosus had isolated deposits of any one immunoreactant, while the association of immunoreactants (IgM+IgG) and (IgM+IgG+C3) characteristic of confirmed systemic lupus erythematosus occurred in only 27.7 and 5.5% of cases, respectively. It should be noted that the C1q immunoreactant was detected in the skin biopsies with both confirmed (38.2%) and probable systemic lupus erythematosus (39%). The data obtained suggest that lupus band test with the presence of a specific pattern of immunoreactants can be used as an additional diagnostic test for the diagnosis of systemic lupus erythematosus.

Relevance. Treatment of liver cirrhosis is an extremely important problem of modern medicine. Improvement of liver function in this category of patients is important not only for hepatology, but also for surgery, since surgical interventions on the liver in this pathology are often accompanied by the development of liver failure. Purpose. To evaluate the effect of cell therapy on liver function in the experiment. Materials and methods. The article presents the results of the experimental use of use of stem cells in simulated liver cirrhosis. The experiment was performed on 132 female c57black mice, which were between 12 and 18 weeks old. After forming a model of liver cirrhosis, in order to assess the effect of cell therapy on the function of liver tissue, individuals were injected with stem cells through the vessels of the peripheral bed and intraportally. 30 days after cell therapy, the blood levels of ALT, AST, alkaline phosphatase, plasma diene conjugants, plasma malondialdehyde, plasma superoxide dismutase, and glutathione peroxidase were evaluated. Conclusion. According to the findings, obtained in the experiment, the use of cell therapy against the background of simulated cirrhosis of the liver contributed to a decrease in the severity of cytolytic and cholestatic syndromes, stimulation of liver protein function, suppression of free radical oxidation and stimulation of the antioxidant system. At the same time, the best effect was achieved when the cell structures were introduced not into the peripheral vessels, but directly into the vascular bed of the liver.

Introduction. More than 30 million cases and more than 970 thousand fatalities from COVID-19 have been registered. The effectiveness of interleukin-6 and interleukin-1 antagonists and janus kinase inhibitors in the treatment of new coronavirus infection is still being analyzed. At present, the emphasis is placed on the introduction into a wide practice of a Russian vaccine named Sputnik V. Purpose. To compare the effect of complex therapy with baricitinib and dexamethasone on the course of COVID-19 interstitial pneumonia. Materials and methods. A retrospective analysis of the medical records of 122 people hospitalized at the North-Western State Medical University named after I.I. Mechnikov was carried out. All the patients were divided into three groups: the first one 64 patients who received therapy including baricitinib; the second one 33 patients whose therapy included dexamethasone; the third one 25 patients in the comparison group. Results. In the first group of patients the lung damage was 25-75% (2-3 degree CT) in 78.1% of the patients, more than 75% in 14.1% of the patients, which was accompanied by severe clinical symptomatology and high laboratory activity. Against the background of the tharapy, positive dynamics of CT was observed in 48.4% of the cases. In the second group of patients the volume of pulmonary tissue damage by CT of 2-3 degrees was observed in 84.9% of the examined patients, clinical and laboratory activity corresponded to the moderate course of the disease. Against the background of the complex therapy, positive dynamics according to CT examination was observed in 18.2% of the cases. In the comparison group, positive dynamics according to CT was observed in 56% of the patients against the background of the therapy. Normalization of clinical and laboratory parameters was observed in all the patients from three study groups on the background of treatment. Conclusions. In the first group the majority of the patients had he highest number of comorbid pathologies and severe course of COVID-19. Normalization of clinical and laboratory parameters was observed in all the groups of patients. As a result of standard comprehensive therapy, as well as therapy involving baricitinib or dexamethasone, positive dynamics according to CT data was observed in 48.4%, 18.2% and 56% of the patients, respectively.

Introduction. According to numerous studies, the prevalence of asymptomatic hyperuricemia has increased in most countries. Uric acid is an important biomarker of the cardiovascular system, and there are now quite a big number of sources indicating its role in the development of a some chronic metabolic conditions, cardiovascular disease and associated mortality. At present, there is no consensus on the need for urate-lowering therapy in patients with asymptomatic hyperuricemia. There is a limited number of studies examining the problem of asymptomatic hyperuricemia in patients with rheumatic diseases, the features of comorbidity in these conditions, the frequency and effectiveness of urate-lowering therapy. Purpose. To study the peculiarities of the course of rheumatoid arthritis and osteoarthritis with associated asymptomatic hyperuricemia and compare them with the ones associated with arthragra. Materials and methods. The analysis was performed on the basis of the data collected from the city register of the patients with arthragra and asymptomatic hyperuricemia in St. Petersburg. The data collected included the medical records of 1725 patients with arthragra, 433 patients with rheumatoid arthritis and hyperuricemia and 355 patients with osteoarthritis and hyperuricemia. Results. The patients with rheumatoid arthritis and hyperuricemia were more likely to have increased erythrocyte sedimentation rate and C-reactive protein, the highest medium level of erythrocyte sedimentation rate; acute myocardial infarction, chronic heart failure, gallstone disease and non-alcoholic fatty liver disease were more frequently detected. The patients with osteoarthritis and hyperuricemia were more likely to have high total cholesterol, at its highest medium level; stable angina, arrhythmia, varicosity, obesity, prediabetes and type 2 diabetes mellitus were more likely to be detected. Kidney damage was detected more frequently in the patients with arthragra. In the group of rheumatoid arthritis and hyperuricemia urate-lowering therapy was started in 30.95% of the patients, in the group of osteoarthritis and hyperuricemia in 36.06%. Conclusions. In rheumatic diseases, hyperuricemia is a common associated condition. Their combination leads to increased risk and frequency of cardiovascular, metabolic and gastroenterological comorbidity. The prescription of urate-lowering therapy to the patients with rheumatic diseases and asymptomatic hyperuricemia with high cardiovascular risk led to the target uric acid levels in 34.58% of the patients with rheumatoid arthritis and 52.08% of the patients with osteoarthritis.

This article considers capillaroscopic changes in the patients with systemic sclerosis compared to the patients with a group of rheumatological diseases (rheumatoid arthritis, polymyositis, osteoarthritis) and the patients with idiopathic pulmonary hypertension. All the patients diagnosed with systemic sclerosis according to nailfold capillaroscopy had a characteristic combination of capillary disorders (Raynauds syndrome): the expansion of all three segments of the capillary loop, the loss of capillaries, and the destruction of the nail fold. In the comparison groups, the capillaroscopic picture was represented by single pathological changes that did not add up to the pathognomonic scleroderma patterns, with the exception of the groups with dermato/polymyositis, where 2 patients had significant Raynauds syndrome. There were also significant differences in the density of the capillaries in the patients with systemic sclerosis in comparison with the other groups.

Relevance. Verification of a new coronavirus infection (COVID-19) requires clear algorithms for the diagnosis and treatment of patients, depending on clinical, laboratory and instrumental dates. Timely and informed decisions on optimizing management tactics and prescribing proactive anti-inflammatory therapy before development of a complete symptom complex life threatening conditions are needed in some cases. Aim of the study. To analyze the course and outcomes of a new coronavirus infection, depending on the initial characteristics of the patients and treatment options. Materials and methods. A preliminary analysis of the case histories of 129 people hospitalized in the center for treating patients with a new coronavirus infection at North-Western State Medical University n.a. I.I. Mechnikov was made by random sampling. Among the hospitalized patients there were 67 men (51.9%), the average age was 57.9 16.4 years, 62 women (48.1%), and the average age was 60.2 13.6 years. During hospitalization, all patients underwent standard clinical laboratory and instrumental examination, as well as determination of saturation (SpO2), markers of the cytokine storm (CRP, ferritin, AST, D-dimer, fibrinogen, lymphocytes), compute tomography (CT) of the lungs. The effectiveness and safety of therapy was evaluated by the outcome (recovery, death), as well as by the presence of adverse events in the background of the therapy. Statistical processing of the research results was carried out using the Statistica 12 for Windows application software package, the significance of differences between the two relative values was evaluated using the Student t-test (t 2, p 0.05). Results. Fatal outcomes were significantly more frequently recorded among patients of older age groups and males. The presence of concomitant diseases such as obesity, diabetes mellitus, pathology of the cardiovascular system was accompanied by more frequent fatal outcomes. That allows considering comorbidity as a risk factor for severe course and poor prognosis of COVID-19. However, in general, in the presence of the indicated forms of concomitant diseases, it was not possible to establish significant differences with the outcomes of COVID-19, which may be due to an insufficient amount of patients. Predictors of fatal outcome was low values of saturation, the presence of respiratory failure, a significant amount of lung tissue damage (CT-3-4), as well as high values of CRP, ferritin, AST, D-dimer, neutrophilia, lymphopenia, thrombocytopenia. The use of anticytokine drugs (ACD) in complex therapy can be considered a favorable predictor of outcome, which indicates the advisability of wider use. The materials of the study allow not only a preliminary assessment of the course and effectiveness of complex therapy using anticytokine drugs with COVID-19 in patients with comorbid diseases, but also to develop therapeutic and diagnostic algorithms in patients of this category.

Summary Background Patients with inflammatory diseases, such as rheumatoid arthritis, often receive glucocorticoids, but long-term use can produce adverse effects. Evidence from randomised controlled trials to guide tapering of oral glucocorticoids is scarce. We investigated a scheme for tapering oral glucocorticoids compared with continuing low-dose oral glucocorticoids in patients with rheumatoid arthritis. Methods The Steroid EliMination In Rheumatoid Arthritis (SEMIRA) trial was a double-blind, multicentre, two parallel-arm, randomised controlled trial done at 39 centres from six countries (France, Germany, Italy, Russia, Serbia, and Tunisia). Adult patients with rheumatoid arthritis receiving tocilizumab and glucocorticoids 5–15 mg per day for 24 weeks or more were eligible for inclusion if they had received prednisone 5 mg per day for 4 weeks or more and had stable low disease activaity, confirmed by a Disease Activity Score for 28 joints–erythrocyte sedimentation rate (DAS28-ESR) of 3·2 or less 4–6 weeks before and on the day of randomisation. Patients were randomly assigned 1:1 to either continue masked prednisone 5 mg per day for 24 weeks or to taper masked prednisone reaching 0 mg per day at week 16. All patients received tocilizumab (162 mg subcutaneously every week or 8 mg/kg intravenously every 4 weeks) with or without csDMARDs maintained at stable doses during the entire 24-week study. The primary outcome was the difference in mean DAS28-ESR change from baseline to week 24, with a difference of more than 0·6 defined as clinically relevant between the continued-prednisone group and the tapered-prednisone group. The trial is registered with ClinicalTrials.gov , NCT02573012 . Findings Between Oct 21, 2015, and June 9, 2017, 421 patients were screened and 259 (200 [77%] women and 59 [23%] men) were recruited onto the trial. In all 128 patients assigned to the continued-prednisone regimen, disease activity control was superior to that in all 131 patients assigned to the tapered-prednisone regimen; the estimated mean change in DAS28-ESR from baseline to week 24 was 0·54 (95% CI 0·35–0·73) with tapered prednisone and −0·08 (–0·27 to 0·12) with continued prednisone (difference 0·61 [0·35–0·88]; p Interpretation In patients who achieved low disease activity with tocilizumab and at least 24 weeks of glucocorticoid treatment, continuing glucocorticoids at 5 mg per day for 24 weeks provided safe and better disease control than tapering glucocorticoids, although two-thirds of patients were able to safely taper their glucocorticoid dose. Funding F Hoffmann-La Roche.

Purpose. The study assesses the impact of tocilizumab immunogenicity markers on clinical response to conducted treatment in patients with rheumatoid arthritis. Materials and methods. A total of 17 patients with the confirmed diagnosis of RA receiving tocilizumab therapy for more than 1 year were enrolled into the study. Blood serum samples were collected once every six months before every drug injection during 2.5 years of treatment. The concentration of antibodies to tocilizumab and level of tocilizumab was determined using the ELISA. Additionally, DAS28 values were measured at the first and the last patient visit during the course of study, whereas levels of C-reactive protein (CRP), white blood cells, platelets, rheumatoid factor, and circulating immune complexes were only measured at the last examination. Results. Positive correlations between the antibodies to tocilizumab and the last point DAS28 values were found, as well as a negative correlation of tocilizumab level and the level of DAS28. Conclusions. The data obtained indicate a significant effect of serum levels of tocilizumab, as well as of the concentration of antibodies to tocilizumab on the effectiveness of RA treatment. A routine study of these biomarkers might be useful for individualizing treatment approaches for RA patients and determining the causes of tocilizumab resistance.

Netakimab is a humanised camelid-derived monoclonal antibody targeting interleukin-17A. Here, we report the results of post-hoc analysis of the ASTERA phase 3 study (NCT03447704, February 27, 2018) in patients with active radiographic axial spondyloarthritis (r-axSpA) grouped by baseline C-reactive protein (CRP), baseline sacroiliac joint (SIJ) inflammation through magnetic resonance imaging (MRI) or presence of peripheral arthritis (PA).In this double-blinded, multicentre, randomised, placebo-controlled, phase 3 ASTERA study, 228 adult patients with active r-axSpA received 120 mg of subcutaneous netakimab or placebo at weeks 0, 1, 2, and thereafter every other week. For the subanalysis, 16-week data of 114 netakimab-treated patients with the available baseline CRP and SIJ MRI were grouped by normal (5 mg/L) or abnormal (≥5 mg/L) CRP, by the grade of sacroiliitis (SI) based on the SPARCC MRI score2 (MRI-SI-) or ≥2 (MRI-SI+), or by the presence of PA. ASAS-recommended activity, spinal mobility, and function endpoints for r-axSpA were analysed.At week 16, an improvement in all the outcomes was similar for MRI-SI- and MRI-SI+ patients, except for a change in ASspi-MRI-a which was significantly greater in MRI-SI+. Netakimab was effective regardless of baseline CRP and PA. For patients with CRP ≥5 mg/L, a more pronounced decline in r-axSpA activity was observed with a trend towards the most prominent improvement in ASDAS-CRP and BASDAI for patients with CRP20 mg/L.Subcutaneous netakimab is effective in patients with r-axSpA irrespective of baseline CRP and inflammation on SIJ MRI. The benefit in patients with high CRP (20 mg/L) was more pronounced.

This is the case report of an acute allergic reaction in a patient with psoriatic arthritis due to a single intake of low-dose methotrexate. We review the presentation, laboratory tests and results of autopsy. The management of the disease and its outcome were analyzed according to current treatment recommendations for psoriatic arthritis.

This article covers the development of a prototype portable telemedicine complex. This complex is designed to increase accessibility and quality of emergency medical service in the Russian Federation, especially its remote regions (including arctic zone). The development is proposed as an instrument for digital transformation and optimization of health care service, that includes technical, methodical and structure improvement of primary care setting and emergency medical care and using new instrumentation, digital and telemedicine technologies.

In conclusion, looking through the presented works and data at the first saint petersburg annual meeting allowed the participants to obtain a reliable view of the most recent and upcoming evidence that might affect our practice in autoimmune diseases. After this meeting, clinicians became more familiar with the key role that diets (curcumin, capsaicin, chocolate and salt), adjuvants, viral agents and microbiome playing in promoting/protecting to/from the development of autoimmune diseases. Moreover, participants became more aware of the contribution of serological tests to the diagnosis and classification of autoimmune diseases. Therefore, we are convinced that this is the real added value of meetings which are capable of gathering researchers from different areas to provide a fertile field for contamination and future projects.

Antiphospholipid antibodies (aPL): lupus anticoagulant (LA), anticardiolipin antibodies (aCL) and anti-β2-glycoprotein I antibodies (anti-β2GPI) are found in 12 to 44% of systemic lupus erythematosus (SLE) patients. On average, antiphospholipid antibody syndrome (APS) develops in50% of aPL-positive patients with SLE. The seronegative APS is characterized by the absence of the diagnostic levels of "classical" aPL and by the presence of non-criteria aPL: antibodies against pro- thrombin (aPT), antibodies against annexin V, antibodies against phosphatidylethanoamine (aPE), antibodies to phosphatidylserine/prothrombin complex (aPS-PT) and antibodies against negatively charged phospholipids. The presence of four antibodies (LA + aCT + anti-β2GPI + aPT) is associated with a threefold increase in the risk of thrombosis. The presence of aCL and anti-β2GPI in SLE patients with APS and recurrent thromboses is associated with the HLA dRB1 * 0402.

The article analyzed the features of the existing system of treatment’s payment in patients with osteoarthritis. The main features of the billing during the transition of the patients hospitalization pay- ment to the system using diagnostic-related groups defines. The main advantages and disadvantages of these systems are analyzed, ways of the economic results optimization of osteoarthritis patients treat- ment are determined with in connection with the planned transition to payment using the clinical- statistical groups. Presented method of the economic efficiency evaluation of paying for treatment can be recommended for use in any other nosological forms of diseases.

Background: In the previous phase 1 study BCD-089 (INN: levilimab) was well-tolerated, had favorable safety profile and low immunogenicity1. Here we report 12-week efficacy and safety results of ongoing phase 2 clinical study of BCD-089 in patients with active RA. Objectives: This study is aimed to assess efficacy and safety of 2 dosing regimens of BCD-089 in patients with MTX-IR active RA. Methods: During this multicenter double-blind placebo-controlled randomized clinical study (NCT03455842) 105 MTX-IR patients with active RA (ACR2010) were assigned (1:1:1) to receive 162 mg of BCD-089 s.c. (QW arm and Q2W arm) or PBO. MTX (10-25 mg/week) was used in all groups. After completion of 12-week blinded period patients from QW/Q2W arms continued the treatment, patients from PBO arm were switched to BCD-089 Q2W until Wk56. The primary efficacy endpoint was the rate of ACR20 at Wk12. Secondary endpoints included ACR50/70 and DAS28-CRP(4). The safety was routinely evaluated. Results: The efficacy analysis showed that 95% confidence interval for BCD-089 treatment effect relative to PBO was [38.45 – 81.55] for QW arm and [16.53 – 63.4] for Q2W arm, which confirms the superiority to PBO of either dosing regimens. Summary of efficacy results is presented in table 1. The majority of adverse events (AE) were laboratory abnormalities. The spectrum of AEs is similar to other IL6R inhibitors (Table 2). Three serious AE (SAEs) were reported: community-acquired pneumonia (QW arm, treatment-related), acute cholecystitis (PBO arm, not related, did not lead to treatment discontinuation), and acute heart failure leading to death (Q2W arm, not related). One case of moderate local reaction (erythema) was reported in QW arm. Conclusion: BCD-089 in combination with MTX had superior efficacy compared with MTX plus PBO in MTX-IR patients with active RA. BCD-089 showed safety profile consistent with other IL6R inhibitors. Further clinical studies are needed. Reference: [1] Khlyabova P, et al. doi: 10.1136/annrheumdis-2018-eular.2410 Disclosure of Interests: V Mazurov Grant/research support from: JSC BIOCAD, Evgeniy Zotkin: None declared, Elena Ilivanova Grant/research support from: JSC BIOCAD, Tatyana Kropotina Grant/research support from: JSC BIOCAD, Tatyana Plaksina Grant/research support from: JSC BIOCAD, Olga Nesmeyanova Grant/research support from: JSC BIOCAD, Nikolaj Soroka: None declared, Alena Kundzer: None declared, Anton Lutskii Employee of: JSC BIOCAD, Ekaterina Dokukina Employee of: JSC BIOCAD, Ekaterina Chernyaeva Employee of: JSC BIOCAD, Roman Ivanov Employee of: JSC BIOCAD

Background: Monitoring of height and body mass index (BMI) is an important for patients with axial spondyloarthritis (axSpA). Reduction of height not only reflects spine remodeling, but affects various indexes, such as BMI (fig.1). However, BMI calculations assume that the adult patient‘s height is a constant. Therefore these calculations may be inaccurate in patients whose height is susceptible to decrease. Objectives: To evaluate changes in height and BMI over time in patients with axSpA, treated with tumor necrosis factor-α inhibitors (iTNF-α). Methods: The study included 51 patients with axSpA (ASAS criteria 2009). All the patients were treated with iTNF-α for one and > years. The patient’s height and weight measured before the beginning TNF-α inhibitors and during the treatment. Only patients with stable weight (variability ± 2.0 kg from baseline) were included in the study. Results: Mean age of axSpA patients at baseline was 40.22±13.51, 38 (74.5%) were male, disease duration 12.77±6.82, duration of TNF-α inhibitors treatment 5.64±2.21 years, all the patients had inactive disease. In 19 patients with axSpA diagnostic delay was 8 years. Patients’ height varied between 1.55 – 1.92 m (average height 1.73±0.07 m). Male’s mean height was 1.78±0.05 m, women’s – 1.63±0.05 m. Height decrease over time in patients with axSpa was 3.74±1.83 cm (from 1.0 to 15.0 cm). Maximal decrease in height was shown in patients with 10 years after the first symptoms emerged. Mean weight in patients who had height loss was 79.75±12.7 kg. Among patients who had decrease of height and stable body mass the difference between BMI at subsequent measurement and the time of treatment initiation (ΔBMI) was 1.15 kg/m2: BMI at baseline = 26.25±3.34 kg/m2, over time of observation BMI = 27.39±3.38 kg/m2). Conclusion: Height loss in axSpA is significant even in patients with inactive disease. Height loss affects BMI calculation that could lead to overestimation of cardiovascular risk, obesity and could change all of the BMI-dependent areas. Correction of BMI calculation for the patients with unstable height is needed. Disclosure of interests: Elizaveta Vasilenko: None declared, Olga Nikolaeva: None declared, anna Dadalova: None declared, Ekaterina Gaydukova: None declared, V Mazurov Grant/research support from: JSC BIOCAD, inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: paiment from Pfizer, Novartis, abbvie, Biocad, Selgene, MSD, Sanofy not exceed 10 000 euros

Background chronic pain, stiffness, fatigue and limited spinal mobility significantly affect quality of life (QoL) in patients (pts) with axial spondyloarthritis (axSpA). There is increasing evidence that IL-17 blockade is highly effective in this pts’ population and show benefits in terms of multiple patient-reported outcomes (PROs) in both non-radiological (nr) and radiological (r) axSpA. Objectives To evaluate early effects of netakimab (NTK) on PROs in pts with active r-axSpA, based on data of 16-week observation from ongoing phase 3 ASTERA study (NCT03447704). Methods ASTERA is a phase 3 international double-blind placebo(PBO)-controlled clinical study. After completion of screening 228 eligible adult pts with r-axSpA (mNew York criteria, 1984), which remained active (BASDAI ≥ 4.0) despite the standard non-steroidal anti-inflammatory drugs (NSAIDs), were randomly assigned (1:1) to receive 120 mg NTK or placebo (PBO) at Week (Wk) 0, 1, 2 and then q2wk through Wk 16. After Wk 16 all patients will continue/be switched to receive NTK up to week 52. PROs were total back pain (10-item numerical range scale), BASDAI, BASFI. Work productivity and QoL were also assessed by Work Productivity and Activity Impairment (WPAI) and 36-item Short Form Health Survey (SF-36), respectively. Results Baseline characteristics were similar between treatment arms. The mean age at baseline was 39.14±9.99 years, 75.88% of patients were male and the mean symptoms duration was 4.3±4.48 years. All patients had active (mean BASDAI: 6.21±1.55) r-axSpA, 76.8% of patients were naive to any biological treatment. Mean total back pain score at baseline was 6.7±1.6 in NTK group and 6.8±1.5 in PBO arm. At Wk1 the difference in total back pain score between study arms became statistically significant (Figure 1). At Wk 16 use of NTK was associated with statistically significant improvements from baseline in BASDAI (-2.8 vs 0.2, p Conclusion NTK in treatment of patients with r-axSpA showed rapid improvement in PRO, WP and QoL and was accompanied with improvement in physical function and disease activity. Disclosure of Interests Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: paiment from Pfizer, Novartis, Abbvie, Biocad, Selgene, MSD, Sanofy does not exceed 10 000 euros, V Mazurov Grant/research support from: JSC BIOCAD, Shandor Erdes Grant/research support from: JSC BIOCAD, Speakers bureau: JSC BIOCAD, Tatiana Dubinina: None declared, Olga Nesmeyanova Grant/research support from: JSC BIOCAD, Elena Ilivanova Grant/research support from: JSC BIOCAD, Alena Kundzer: None declared, Nikolaj Soroka: None declared, Ekaterina Dokukina Employee of: JSC BIOCAD, Anna Eremeeva Grant/research support from: JSC BIOCAD, Ekaterina Chernyaeva Employee of: JSC BIOCAD, Roman Ivanov Employee of: JSC BIOCAD

Non-steroidal anti-inflammatory drugs (NSAIDs) are most popular medications for the treatment of pain in common musculoskeletal diseases such as osteoarthritis (OA) and non-specific low back pain (LBP). However, the factors affecting the effectiveness of these drugs have not been determined fully. Aim: to identify factors affecting the effectiveness of NSAIDs in patients with OA and LBP. Materials and methods. An observational study was conducted to evaluate the effectiveness of a 2-week course of NSAIDs in OA and LBP in real clinical practice. The study group consisted of 3604 patients with OA and LBP (60.6% women and 39.4% men, mean age 55.0±13.4 years). According to the study design, aceclofenac (Airtal) and other NSAIDs used in the ratio 1:1. The main criterion of effectiveness was the frequency of complete pain relief after 2 weeks of therapy. In addition, the decrease of pain and general health were determined on a 10-point numerical rating scale (NRS). We compared the frequency of complete pain relief in patients who had and did not have the studied factors. The value of the studied factors was determined using OR (95% CI). Results and discussion. Most patients received aceclofenac (54.9%), as well as diclofenac (2.0%), ketoprofen (1.9%), lornoxicam (2.2%), meloxicam (13.7%), naproxen (2.1%), nimesulide (5.8%), celecoxib (5.9%), ethicoxib (7.1%) and other NSAIDs (4.4%); 56.2% of patients received muscle relaxants, mainly tolperisone (74.7%), vitamin B (10.4%), and proton pump inhibitors (42.8%). Complete pain relief was achieved in 54.8% of patients. The pain decrease and general health improvement were (for NRS) 63.9±13.4% and 61.7±14.8%, respectively. The efficacy of aceclofenac was slightly higher than in the whole group: complete pain relief was in 59.9% of patients. Adverse events in aceclofenac use were observed in 2.3% of patients, other NSAIDs-from 2.4 to 14.1%. The frequency of complete pain relief was higher in men: OR 1,239 (95% CI 1.08-1.418; p=0.002), who had the first episode of pain - OR 3.341 (95% CI 2.873-3.875; p=0.000), a good" response " to NSAIDs in history - OR 1.656 (95% CI 1.385-1.980; p=0.000) and received NSAIDs in combination with muscle relaxants - OR 1.218 (95% CI 1.067-1.390; p=0.004). The effect of therapy is lower in patients 65 years and older-OR 0,378 (95% CI 0.324-0.442; p=0,000), with body mass index >30 kg/m² - OR 0.619 (95% CI 0.529-0.723; p=0.000), with severe pain (≥7 points NRS) - OR 0.662 (95% CI 0.580-0.756; p=0.002), with pain at rest, - OR 0.515 (95% CI 0.450-0,589; p=0.000), pain at night - OR 0.581 (95% CI 0.501-0.672; p=0.000) and the presence of stiffness - OR 0.501 (95% CI 0.438-0,573; p=0.000). Treatment results are significantly worse in the cases of combination of LBP and joint pain, as well as pain in the trochanter major and pes anserinus area (p

Obesity and its attendant neurohormonal regulatory violations and play a leading role in the development and progression of insulin resistance (IR), which is the principal risk factors of the metabolic syndrome (MS). Identifying predictors of MS in childhood is of great clinical importance, since the adequate treatment of this condition is reversible. The aim of the study was to investigate the clinical manifestations, metabolic and hormonal disorders in primary obesity, depending on the presence of comorbid conditions in children. In the endocrinology department at Children's Hospital №1 of St. Petersburg in 2008-2011 observed 20 children aged 8 to 17 years (boys - 14, girls - 6) with primary obesity. The survey included children study of heredity; objective examination of the analysis of physical development, evaluation of blood pressure; study hemogram, biochemical analysis of blood parameters and hormonal status; the results of instrumental studies of the cardiovascular system and digestive tract. Patients have formed two groups: 13 children with primary obesity without comorbid conditions (group 1) and 7 children with complicated comorbidity primary form of obesity (group 2). Isolation of children in Group 2 of the total weight of obese patients was conducted taking into account the identification of IR. Studies have shown that the complicated form of primary comorbidity of obesity was more common in males and is characterized by hemodynamic and hormonal changes indicating a possible risk of developing MS. At the same time, the expression of lipid metabolism, the frequency of functional pathology of the cardiovascular system and digestive tract diseases did not differ among children in group 1 and group 2.

Aim. Assessment of patients with different rheumatic diseases and studying of markers of subclinical course of involvement of target organs (the heart, vessels, kidneys), with consequent analysis of their relation to the level of ADMA. Material and methods. Totally 162 patients included in the study, with RD (RA, SSD, AS), 63 without rheumatic pathology with more than 2 factors of cardiovascular risk, and 10 healthy volunteers. All patients were examined by rheumatologist and cardiologist, the anamnesis was collected and physical examination with anthropometry. Of laboratory tests we performed creatinine measurement, glucose, total cholesterol, C-reactive protein (C-RP), ADMA. Estimated glomerular filtration rate was calculated by MDRD equation. Functional assessment included EchOCG, ultrasound visualization of carotid arteries and vessel stiffness evaluation. Data processing was done using the software Statistica 8.0 (StatSoft Inc., USA), and Prism 5 for Windows, version 5,03, GraphPad Software, Inc., USA).Results. Analyzing subclinical involvement of target organs in it found that, as in R D, in the comparison group patients the parameters of the pulse wave velocity, glomerular filtration rate, left ventricle hypertrophy were not out of normal range. The main changes affected intima-media complex thickness, thatwas the highest in rheumatoid arthritis, and the beginning renal disease was characteristic for systemic sclerodermia patients. These same subgroups of ADMA were the highest and correlated with the studied parameters the same way as in the group of patients with more prominent atherosclerotic disease.Conclusion. The earliest sign of subclinical involvement of target organs in rheumatic diseases is remodeling of vessel wall. ADMA can be a mediator of atherosclerosis progression in rheumatic diseases as in patients with the combination of traditional risk factors of cardiovascular diseases.