Introduction. Radiographic progression (RP) of rheumatoid arthritis (RA) is one of the main signs of the disease and a key factor in assessing the effectiveness of therapy. RP is accompanied by an increase in the number of erosions, narrowed joint spaces, and radiographic stage (Rg stage). The aim – to compare the characteristics of patients with rheumatoid arthritis with rapid and slow rates of radiographic progression during long-term follow-up. Materials and methods . A prospective cohort study lasting 9.7±1.7 years included 151 women with RA aged 53.9±9.2 years. All patients underwent clinical, laboratory, and radiographic examinations. RP was analyzed taking into account changes in the Steinbrocker RA stage, the number of erosions, and the degree of joint space narrowing using the Sharp/van der Heijde (SVH) method. Results . An increase in the erosion count according to SVH was detected in 66 (53%) patients, and narrowed clefts – in 81 (65%) patients. The number of patients with Rg1, Rg2, and Rg3 decreased; those with Rg4 increased from 29 (19%) to 54 (36%) people (p<0.05). Slow RP (Rg1–Rg2 in dynamics) was observed in 63 (42%) patients, and rapid RP (increase in Rg stage) – in 32 (21%) patients. In 56 (37%) patients, the Rg stage did not change. Rapid RP is associated with a younger age at RA onset and inclusion in the study, with a longer duration of RA, with a higher matrix metallopeptidase 3 index and interleukin 6 level above normal in dynamics, with a lower dose of methotrexate both in monotherapy and in combination with other agents; with a higher average daily and cumulative dose of glucocorticoids. Conclusions. A long-term prospective study demonstrated RP despite achieving remission and decreasing activity in the majority of RA patients. The rate of RP depends on many factors, both RA-related and non-RA-related. Distinguishing phenotypes of RA patients with rapid and slow RP will enable a personalized approach to patient management.

The aim – to evaluate the effect of olokizumab (OKZ) on acute-phase reactants, interleukin (IL) 6, and its soluble receptor (sIL-6R) levels in patients with rheumatoid arthritis (RA) and comorbid depression. Material and methods . A total of 125 patients with RA and comorbid depression were included, including 102 (81.6%) women, with a mean age of 48.5±12.6 years. The majority (86.4%) had high RA activity and had failed stable 12-week therapy with synthetic disease-modifying antirheumatic drugs (DMARDs). Thirty-four (27.2%) patients had failed one or more biological agents. At week 0, all patients were randomized using the sequential numbers method in a 2:2:1 ratio to one of three groups: Group 1 received treatment with sDMARDs + OKZ 64 mg subcutaneously once every 4 weeks (n=49); group 2 – sDMARDs + OKZ 64 mg subcutaneously + psychopharmacotherapy (PPT) (n=51); group 3 – sDMARDs + PFT (n=25). The study duration was 24 weeks. Serum IL-6 concentrations were determined using xMAP multiplex technology on a Bio-Plex Array System analyzer (Bio-Rad, USA) and immunochemiluminescence assay (ICL) on a Cobas e411 analyzer (Roche, Switzerland). Results. The use of OKZ was accompanied by a significant decrease in the level of C-reactive protein (CRP) and calprotectin (CP) in the group as a whole; normalization of the CRP level was noted 4 weeks after the start of therapy (p<0.05). When comparing the groups of patients who achieved (n=50) and did not achieve remission (n=50) according to the EULAR (European Alliance of Associations for Rheumatology) criteria (according to DAS28-CRP (Disease Activity Score 28 with CRP determination)) by 24 weeks of OKZ therapy, significant differences were noted in the concentration of CP (respectively, 1.54 [1.2; 2.56] versus 2.42 [1.5; 4.54] μg/ml; p=0.022) in contrast to CRP (0.45 [0.2; 0.7] versus 0.6 [0.2; 0.9] mg/ml). There was a significant decrease in the concentration of IL-6 in the group as a whole by 5.5 times after 12 weeks and by 3.5 times after 24 weeks of therapy. The level of sIL-6R decreased in the group as a whole and among patients with a good response to therapy (p<0.05). Conclusion . Thus, the use of OKZ is accompanied by a decrease in the levels of acute-phase reactants, CP, IL-6, and sIL-6R. CP can be considered a more sensitive marker for assessing inflammation during OKZ therapy compared to CRP.

Polymyalgia rheumatica (PMR) is a prevalent immune-mediated inflammatory rheumatic disease that typically affects individuals over the age of 50. Despite significant advances in the diagnosis and treatment of PMR, challenges remain in the objective assessment of disease activity, which hinders the development and implementation of the treat-to-target (T2T) strategy. Diagnosis is primarily based on clinical symptoms and laboratory markers of inflammation—most notably, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). However, the diagnostic value of these markers is reduced in patients receiving interleukin-6 inhibitors, emphasizing the need for alternative biomarkers. The Polymyalgia Rheumatica Activity Score (PMR-AS) and its modifications (CRP-PMR-AS, ESR-PMR-AS, and clin-PMR-AS) are among the most thoroughly studied tools for the quantitative assessment of disease activity. The potential of imaging modalities such as ultrasound and magnetic resonance imaging (MRI) is also being actively explored for visualizing structural changes and assessing inflammatory activity in PMR. These techniques have demonstrated high sensitivity and specificity but require further standardization and validation of their clinical relevance. The development of a comprehensive monitoring strategy based on validated indices and objective biomarkers may serve as a foundation for the creation of national clinical guidelines and facilitate the successful implementation of the T2T approach in routine rheumatologic practice.

In immuno-mediated rheumatic diseases (IMRD), laboratory biomarkers, which include autoantibodies, proteins of the acute phase of inflammation, cytokines, markers of endothelial damage, components of the complement system, subpopulations of lymphocytes, indicators of bone metabolism, and many others, occupy a central place in the diagnosis, assessment of activity, and monitoring of the effectiveness of pharmacotherapy. In the range of biomarkers of inflammation in recent years, special attention has been drawn to calprotectin (CP), which is a heterodimeric complex of S100A8 and S100A9 calcium-dependent proteins. Currently, to characterize inflammation in IMRD, attention is drawn to determining the concentration of CP in biological fluids, the so-called circulating or serum (s) CP, an increase in the concentration of which may be more associated with local (in situ) than with systemic synthesis of protein. The narrative review summarizes the clinical significance of the sCP determination in IMRD as a new biomarker of inflammation. Preliminary recommendations regarding indications for determining the sCP in IMRD are presented.

The aim of the study – to evaluate the safety and influence of tenoxicam (Texared®) on the duration and severity of morning stiffness, spinal pain at night, activity and function in patients with ankylosing spondylitis (AS) Materials and methods. The study included 30 patients (aged 18 to 60) with AS who sequentially sought medical care at the V.A. Nasonova Research Institute of Rheumatology and voluntarily signed an informed consent form to participate in the study. Most patients (66.7%) were male. The average age of patients was 37.6±9.5 years, and the average duration of the disease was 134.5±92.3 months. HLA-B27 antigen positivity was detected in 76.7% of cases. All patients who voluntarily agreed to participate in the study and signed an informed consent form at the initial visit were prescribed tenoxicam (Texared®) at a daily dose of mg. At week 0, 14 days and 90 days (3 months) after the start of therapy, standard clinical and laboratory examinations were performed. Results and discussion. On the background of regular tenoxicam administration, most patients with AS achieved a reduction in clinical parameters of disease activity compared to baseline and its dynamics after 90 days: a decrease in BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) indices to 3.8 (p<0.016) and ASDAS (Ankylosing Spondylitis Disease Activity Score) to 2.8±1.3 (p<0.011) was noted; the severity and duration of morning stiffness to 3.9±2.5 and 3.0±2.7 (p<0.01 in both cases), respectively; patient assessment of disease activity to 4.1±2.2 (p<0.00); night-time back pain – to 3.0±2.6 (p<0.00). After 14 days of treatment, one third of patients achieved a 20% improvement according to ASAS (Assessment of SpondyloArthritis International Society) criteria. After 90 days, the number of responders was 70.3%. Tolerability of therapy was good in 44.4% of cases. No serious adverse events were recorded during the study. Conclusion. In patients with high and very high AS activity, tenoxicam (Texared®) therapy has been shown to have a positive effect on disease activity, including the severity of night-time back pain and the severity and duration of morning stiffness. The drug is well tolerated and has a favourable safety profile.

The aim of the study was to determine the frequency, assess survival, and characterize the clinical features of systemic lupus erythematosus (SLE) in association with pulmonary arterial hypertension (PAH).Material and methods. According to the results of echocardiographic screening, 8 patients with PAH-SLE were identified after verification of the diagnosis on a right heart catheterization. Two cohorts of patients with SLE observed at the V.A. Nasonova Research Institute of Rheumatology were taken as a comparison group: the first is historical, with a long follow-up period (n=154), the second is modern, with a short duration of the disease (n=400). The analyzed patient groups were examined according to a single scheme, differences in signs and survival were assessed. The intrahospital frequency of PAH in SLE was estimated based on statistical data for the period from 2008 to 2017.Results. Despite the small number of patients in the main group, signs associated with the presence of PAH were identified: predominantly chronic course of SLE, with a long period (6–11 years) the course of the disease before the first clinical signs of PAH, the presence of Raynaud’s syndrome without capillaroscopic changes, Roand Smithautoantibodies. The survival rate of patients with PAH-SLE and the long-term observed SLE cohort did not differ. The in-hospital prevalence of SLE with echocardiographic screening was 0.29%.Conclusion. PAH is a rare manifestation of SLE associated with the features of the course and clinical picture, which does not significantly affect survival when using PAH-specific therapy.

The aim – to compare the efficacy and safety of different doses of colchicine (0.5 mg/day vs 1.0 mg/day) used for the prevention of arthritis attacks in gout patients during the initiation of urate-lowering therapy.Materials and methods. The study included 96 patients diagnosed with gout. Patients were randomized into three groups: those receiving colchicine 0.5 mg/day, colchicine 1 mg/day, and those without anti-inflammatory therapy. All participants were prescribed febuxostat 80 mg/day. The duration of the observation period was 6 months. The frequency and severity of arthritis attacks, as well as the incidence of adverse events, were compared.Results. Patients who did not receive colchicine experienced arthritis attacks more frequently compared to those receiving 0.5 mg/day (p=0.03) and 1 mg/day (p=0.007). In the groups receiving colchicine 0.5 mg/day and 1.0 mg/day, the frequency of attacks did not differ significantly (p=0.6), nor did the proportion of patients who did not experience arthritis attacks – 18 (56%) and 22 (69%), respectively (p=0.3). Among patients not taking colchicine, 9 (28%) did not develop arthritis attacks (p=0.02 compared to those taking 0.5 mg/day and p=0.001 for 1 mg/day). The administration of colchicine 1 mg/day (but not 0,5 mg/day) was associated with lower pain intensity on the visual analog scale during arthritis attacks compared to the non-therapy group (p=0.04). The frequency of adverse events was comparable across the groups.Conclusion. The use of colchicine 0.5 mg/day for the prevention of arthritis attacks in gout patients is justified due to the absence of differences in efficacy compared to the higher dose. However, prescribing colchicine 1 mg/day also demonstrates a good safety profile and may be considered for the prevention of arthritis attacks.

The aim – to study the frequency of left ventricular (LV) myocardial dysfunction and its relationship with disease activity in patients with systemic lupus erythematosus (SLE).Materials and methods. The study included 100 patients with SLE who met the criteria of SLICC/ACR 2012, 87% were women, the average age was 33 [25; 40] years, the average duration of the disease was 1 [1; 9] year, patients with varying degrees of activity according to SLEDAI-2K (low/moderate/high) – 30/45/25 (30%/45%/25%). All the subjects had not previously received biological therapy and had no previously diagnosed cardiovascular diseases and other rheumatic diseases. All patients received glucocorticoids (GCs) and hydroxychloroquine therapy in different dosages depending on the severity of the disease, according to the standards recommended by the Association of Rheumatologists of Russia from 2021. Methotrexate was received by 6% of patients, azathioprine – 14%, cyclophosphamide – 3%, nonsteroidal anti-inflammatory drugs – 81.2%. The control group consisted of 20 healthy individuals, having no signs of rheumatic diseases and CVD comparable in age and gender. All the subjects underwent echocardiography (ECHO) with tissue dopplerography and left ventricle global longitudinal strain (LV GLS) assessment by speckle tracking.Results. Violation of LV GLS was observed in 65 (65%) patients with SLE. In the SLE group, compared with the control group, a significantly more damaged LV GLS was revealed. In all patients with impaired diastolic function of the left ventricular myocardium, deterioration of LV GLS parameters is observed. Impairment of LV GLS correlated with clinical and immunological parameters in patients with SLE: the degree of SLE activity according to SLEDAI-2K (r=0.219), the level of antibodies to double-stranded DNA (a/b to ds-DNA) (r=0.316), the C3 level of the complement component (r=–0.389), the C4 level of the complement component (r=–0.238), the hemoglobin level (r=–0.255), the number of red blood cells (r=–0.286), the level of C-reactive protein (r=–0.284) and CRP (r=–0.927). Also, patients with SLE with diagnosed nephritis (n=26) had a significant violation of LV GLS parameters.Conclusions. In patients with SLE, according to ECHO using the Speckle tracking technique, violation of LV GLS occurs with a high frequency (65%). Violation of LV GLS parameters is associated with SLE activity, immunological and hematological disorders. In all patients with impaired diastolic function of the left ventricular myocardium, LV GLS was obviously decreased. The presence of lupus nephritis is associated with a significant violation of the GLS parameters.

Glucocorticoids are the basis for the treatment of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR), however, their long-term use is associated with a number of well-known side effects. Despite the fact that a significant number of patients with these diseases require long-term treatment, approaches to long-term therapy remain insufficiently developed. The role of traditional anti-inflammatory drugs remains uncertain due to insufficient efficacy and inconclusive evidence base. A possible solution of this problem is the use of biological agents, in particular, affecting the interleukin (IL-6) axis. This series of clinical observations presents the experience of using the IL-6 inhibitor olokizumab in the treatment of GCA and PMR. The data obtained are consistent with the positive international experience of using drugs of this group and demonstrate both efficiency of disease activity control and a pronounced steroid-sparring effect. Olokizumab is a promising drug for the treatment of GCA and PMR.

Lupus nephritis (LN) is considered to be one of the most frequent severe manifestations of systemic lupus erythematosus (SLE), its various colonic manifestations occur in at least 50% of SLE patients, both at the onset and at various stages of the disease, and develop LN is considered one of the most important predictors of mortality in SLE. The structure of nephritis is dominated by diffuse proliferative LN with clinical and morphological signs of progression and the rapid development of terminal renal failure. SLE is diagnosed based on the 2019 EULAR/ACR (European Alliance of Associations for Rheumatology/American College of Rheumatology) diagnostic classification criteria. To confirm the diagnosis, evaluate the prognosis, and choose the tactics of treating the dis-ease, all patients in the absence of contraindications require a kidney biopsy. In addition to LN, the spectrum of SLE-associated renal lesions includes vascular pathology represented by thrombotic microangiopathy, lupus vasculopathy or vasculitis, tubulointerstitial injury, and lupus podocytopathy.