Therapy

Current guidelines are intended for primary care specialists: therapists, general practitioners, and senior medical students. They include basic concepts on clinical course, diagnosis, treatment, monitoring, and prognosis of patients with systemic lupus erythematosus. The material of the guide is presented in adapted sections from modern clinical guidelines of specialized societies, as well as current federal regulatory documents.

Due to the high prevalence of osteoarthritis (OA) and hyperuricemia and their shared risk factors, the combination of these pathological conditions represents a serious problem in real-life clinical practice.

The aim: to determine the features of the course of OA in patients with asymptomatic hyperuricemia (AHU).

Material and methods. The follow-up included 1038 patients with OA who met the inclusion criteria, divided into two groups: 538 patients with AHU and 500 patients with normal serum uric acid (UA) levels.

Results. Elevated serum UA levels in patients with OA were associated with a higher prevalence of lesions of the interphalangeal joints of the hands (9.1 vs 5.6%; p = 0.031), osteonecrosis of various localizations (5.2 vs 2.2%; p = 0.011) and a history of joint replacement (2.6 vs 1.0%; p = 0.044). Bone erosions (14.0 vs 2.3%; p = 0.047), as well as the total number of ultrasound signs of deposits of monosodium urate crystals (24.0 vs 2.3%; p = 0.002), were significantly more frequently reported among patients suffering from AHU. In patients with OA with AHU, the average levels of high-sensitivity C-reactive protein (4.9 [4.0;7.9] vs 2.9 [1.2;6.3] mg/l; p = 0.007) were significantly higher, while serum levels of interleukin (IL)-6 and IL-8 they did not differ significantly. Prevalence of hypertension (80.5 vs 55.5%; p <0.001), heart failure (17.5 vs 6.6%; p <0.001), atrial fibrillation and atrial flutter (5.4 vs 1.8%; p = 0.002), hypercholesterolemia (68.8 vs 62.9%; p = 0.047), chronic kidney disease (54.1 vs 28.1%; p <0.001), type 2 diabetes mellitus (29.2 vs 13.4%; p <0.001) and obesity (49.6 vs 16.4%; p <0.001) were significantly higher in patients with OA with AHU.

Conclusion. Analysis of the data from the study allows us to classify AHU as modifiable risk factors for more severe joint damage and multimorbidity in patients with OA. It can be assumed that non-medicinal and medicinal methods of treating AHU in OA can be useful not only to achieve the target serum UA levels and improve the course of OA, but also to increase the effectiveness of complex therapy for a wide range of comorbid diseases.

Despite the steadily increasing interest to hyperuricemia (HU) as a risk factor for the development and progression of rheumatic diseases, the problem of the combination of HU, systemic lupus erythematosus (SLE) and comorbidity has not been sufficiently studied.

The aim: to estimate the peculiarities of the clinical course and treatment of SLE, as well as the incidence and characteristics of comorbid conditions in female patients with HU.

Material and methods. The data of 187 SLE female patients aged 18–60 years, observed in V.A. Nasonova Clinical Rheumatology Hospital No. 25 were studied. Clinical and laboratory manifestations and treatment of SLE, as well as the structure of comorbid conditions with an increase of serum uric acid (UA) > 360 μmol/l (n = 104) and with UA ≤ 360 μmol/l (n = 83) were compared.

Results. In case of SLE and HU combination (huSLE), a longer duration of the disease and a higher body mass index (BMI) were observed than in case of SLE with normouricemia (nuSLE). In addition, in the first case, skin lesions (33.33 and 27.16%, respectively, p = 0.035), serositis (22.12 and 8.3%, p = 0.005), and after 45 years, lupus nephritis (28.92 and 8.43%, p = 0.03) were more often detected. With comparable activity and frequency of achieving remission, basic drugs were used more often in huSLE than in nuSLE, and the risk of steroid resistance was higher. In patients with huSLE, comparatively to nuSLE, arterial hypertension (AH) (50 and 25.3%, p = 0.0006), chronic kidney disease (CKD) (5.95 and 17.31%, p = 0.008), autoimmune thyroiditis (17.31 and 4.82, p = 0.0097) were more often observed, also there was a higher risk of cardiovascular events (5.3 and 2.8% according to the QRISK3 scale, p = 0.0004) and the Charlson comorbidity index (2.18 ± 1.34 and 1.84 ± 1.07, p = 0.032). Also, in case of huSLE, acute cerebrovascular accidents (ACVA) developed significantly more often than with nuSLE.

Conclusion. Comparatively to patients without HU, 18–60 years old females with SLE and HU had a longer disease duration, higher BMI, higher incidence of arterial hypertension, ACVA, stage 2–3 CKD, autoimmune thyroiditis, lupus nephritis, lower levels of complement fractions C3 and C4, higher erythrocyte sedimentation rate, as well as a higher risk of steroid resistance, cardiovascular events, and the total risk of comorbidity according to the Charlson index. Achieving remission or low SLE activity in case of HU required more frequent use of disease-modifying drugs than in case of normouricemia.

Cardiovascular diseases are the main cause of mortality among patients with rheumatoid arthritis (RA). Until nowadays, cardiovascular risk assessment in patients with RA remains an actual and complex task.

The aim: to perform a comparative analysis of cardiovascular risk (CVR), biological and passport age in patients with RA, with thrombocytosis and normal platelet level.

Material and methods. 85 patients with RA (40 with thrombocytosis and 45 with normal platelet levels) were involved in the study. The average age of the participants was 50.3 ± 9.8 years. The total group included 54 (63.5%) female and 31 (36.5%) male patients. To assess the risk of cardiovascular diseases, the SCORE scales multiplied by a correction factor of 1.5 (mSCORE), RRS, QRISK3 and ASSIGN were used. Passport and biological age of the patient was determined using the QRISK3 scale.

Results. QRISK3 scale made it possible to establish a statistically significant increase in CVR in patients with RA and thrombocytosis comparatively to the group of patients with RA and normal platelet level (p = 0.021). The odds of developing high cardiovascular risk in patients with thrombocytosis were 2.78 times higher comparatively to the group of RA patients without thrombocytosis (95% confidence interval: 1.15–6.73). The use of other scales (mSCORE, RRS, ASSIGN) did not reveal statistically significant differences in high CVR in the compared groups.

Conclusion. QRISK3 scale is the most informative tool for assessing CVR in patients with RA, especially in the presence of thrombocytosis.

Both hyperuricemia (HU) and psoriatic arthritis (PsA) have an adverse influence at cardiovascular, metabolic diseases, and chronic kidney disease (CKD).

The aim: to study the incidence of comorbid diseases, their clinical course, characteristics, and efficacy of urate-lowering therapy (ULT) in case of PsA and HU combination.

Material and methods. Retrospective data of patients with PsA and HU (n = 130) and PsA without HU (n = 131) were studied. HU was considered as an increase in serum uric acid (UA) ≥ 360 μmol/L in the absence of gouty arthritis.

Results. PsA patients with and without HU were comparable in age, gender, disease activity, and immunogenetic characteristics. In the group of patients with PsA and HU, comparatively to PsA without HU, arterial hypertension (68.46 and 40.46%, respectively), hypercholesterolemia (53.08 and 27.48%), obesity (25.38 and 6.87%), prediabetes (21.54 and 12.21%), type 2 diabetes mellitus (DM 2) (29.23 and 12.21%), CKD (51.54 and 29.77%) were more common, in addition, the first group had a higher creatinine level (87.79 ± 19.26 and 77.86 ± 11.42 μmol/l); p < 0.05 for all parameters. Non-medicamentous ULT was effective in 30.36% of patients, medicamentous ULT – in 23.07%. These data can be explained by the fact that examined patients did not comply with the ULT dosing regimen and they stopped such therapy on their own. The efficacy of ULT did not depend on PsA activity: 81.25% of patients with moderate and 55.26% with high disease activity did not achieve the target UA level (p = 0.01).

Conclusion. HU leads to an increase in the incidence of hypertension, dyslipidemia, obesity, prediabetes, DM 2, and CKD in patients having PsA. The efficacy of non-medicamentous and medicamentous-based ULT in such patients is comparable in terms of target UA indicators achieving. It is advisable to continue studying the correlation between PsA activity and the efficacy of ULT.

Connective tissue diseases (CTD) can lead to the development of pulmonary arterial hypertension (PAH) – a rare, but severe and life-threatening manifestation. The main proportion of all patients with PAH-CTD are patients with systemic sclerosis (SSc), characterized by the worst prognosis, but PAH can also be detected in systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD), when the course of the disease is less malignant. Particularly difficult is the detection of asymptomatic, SSc sine scleroderma, in which there is no visible thickening of the skin. Wrong diagnosis can lead to untimely therapy and unfavorable outcomes.

The aim: to assess the prognosis and compare clinical and laboratory characteristics of the SSc sine scleroderma in comparison with other variants of PAH-CTD.

Material and methods. 14 patients with SSc sine scleroderma, 8 patients with SLE and 9 with PAH-associated MCTD were included in the study. CTD diagnosis was made on the basis of current diagnostic criteria, PAH was verified by cardiac catheterization. In all patients, other causes of pulmonary hypertension were excluded – heart disease, lung disease, thrombophilia.

Results. Patients with SSc sine scleroderma were significantly older (48 [35; 56] years), they were 19 times more likely to have telangiectasias, 16 times more likely to have anticentromere antibodies, and 6 times more likely to have high levels of N-terminal propeptide of B-type natriuretic hormone (NT-proBNP) and uric acid. Detection of arthritis, myositis, and antibodies to DNA increased the probability of detecting other CTDs – SLE or MCTD. Survival rate also differed: with SSc sine scleroderma, the median was 58 months, with MCTD – 68 months, and with SLE, the median follow-up was 96 months (p < 0.05).

Conclusion. Comparative analysis allowed us to identify the main predictors of SSc in patients with PAH, which can contribute to timely and early therapy and improve the prognosis of the disease.

Data on the predictive value of matrix metalloproteinases (MMP) and their tissue inhibitors (TIMP) in relation to cirrhosis in case of chronic hepatic disorders diseases (CHD) are limited. It is advisable to search for non-invasive biomarkers of liver cirrhosis (LC) with an emphasis on the components of the MMP system.

The aim: to evaluate the prognostic significance of MMP and TIMP in combination with clinical and laboratory markers for F4 fibrosis (LC) diadnostics in case of CHD.

Material and methods. The study included 76 patients with histologically confirmed CHD of viral or alcoholic etiology. Patients underwent standard clinical, laboratory and morphological examination. Fibrosis F0–F3 was found in 77.6% of patients, F4 – in 22.4%. The enzyme immunoassay method was used to determine the content of MMP-1, MMP-9, TIMP-1 in the blood, TIMP-1/MMP-1 and TIMP- 1/ MMP-9 ratios were calculated.

Results. An increased risk of LC developing (F4 fibrosis) was associated with the following values: TIMP-1 ≥ 624 ng/ml, gamma-glutamyl transpeptidase (GGT) ≥ 67.8 U/l, liver stiffness ≥ 11.1 kPa, albumin ≤ 39.3 g/l, platelets ≤ 173 × 10⁹/l, age ≥ 45 years, TIMP-1/MMP-1 ≥ 37.1 RU, aspartate aminotransferase ≥ 49.3 U/l, TIMP-1/MMP-9 ≥ 7.33 RU, erythrocyte sedimentation rate ≥ 9 mm/h, MMP-1 ≤ 15.3 ng/ml, total bilirubin ≥ 16 μmol/l, direct bilirubin ≥ 8.4 μmol/l, alanine aminotransferase ≥ 65 U/l, as well as the presence of cholestatic, mesenchymal-inflammatory syndromes, moderate/high biochemical activity. According to multivariate regression analysis, F4 fibrosis was associated with TIMP-1/MMP-1 ratio, GGT activity, and age. Model which included these indexes had a sensitivity of 82.4% and a specificity of 94.9% in diagnosing F4 fibrosis (LC) among patients having CHD.

Conclusion. An increased TIMP-1/MMP-1 ratio, increased GGT activity and elderly age are independent risk factors for LC (F4 fibrosis) in case of CHD, due to their influence at fibrogenesis processes. The developed model, designed for non-invasive diagnostics of cirrhosis, can contribute to the timely detection and correction of the disease at early stages.

Article discusses the aspects of interaction between immune and cardiovascular systems, various schemes for the use of immunosuppressive drugs in cardiovascular diseases treatment. In the frames of the analysis of large studies on the use of immunosuppressive drugs in patients with cardiovascular pathology, various aspects of the use of these drugs in cardiology are considered. The authors of the article offer their viewpoint at the problem of the correlation between immune and cardiovascular systems from both theoretical and practical points of view. A search in PubMed, Scopus and Web of Science electronic databases in order to find relevant publications was performed until 01.01.2025 in Russian and English languages using the terms “cardioimmunology”, “immunosuppressive therapy in cardiology”, “anti-cytokine drugs in cardiology”, “JAK inhibitors and cardiovascular diseases”, “glucocorticoids and cardiovascular diseases”. Materials without access to the full text, articles in languages other than Russian and English, as well as publications that did not meet the objectives of the analysis were excluded from the study.

In modern phthisiology, the problem of combination of pulmonary tuberculosis and malignant neoplasms (MN) is actual. According to research data, in case of MN, the risk of tuberculosis arising in patients increases by 6 times. At the same time, the presence of an active tuberculosis process (ATP) in lung tissue increases the probability of lung cancer by 3 times or more. In addition, the interaction of these two diseases can reduce the anti-tumor effect of immune system. This situation can lead to a long-term asymptomatic clinical course of oncological process coming secondary to active pulmonary tuberculosis. The aim of the article is to demonstrate the combination of ATP and asymptomatic clinical course of malignant neoplasms. The presented clinical example demonstrates the difficulties of diagnosis and choice of treatment tactics in such category of patients. Actual direction in modern phthisiology is high oncological alertness to comorbid patients with pulmonary tuberculosis.

Raynaud’s syndrome (RS) is characterized by intense vasospasm of digital arteries when exposed to cold or emotional stress, which leads to clearly defined changes in the color of the fingers’ skin. Clinical manifestations are the result of the imbalance between vasoconstrictor and vasodilator factors. It can be primary or secondary to the main disease, including autoimmune pathology. Physical examination, nail bed capillaroscopy, and immunological tests allow us to differentiate primary from secondary forms of RS. Treatment of this syndrome is based on preventing exposure to cold, emotional stress and taking certain drugs. In the presence of attacks, vasodilators, prostaglandin analogues, etc. can be prescribed. The article focuses on the characteristics of RS and available methods of its diagnosis and therapy.

Chronic pancreatitis (CP) is an important problem in modern gastroenterology, since its pathogenesis is multifactorial, which complicates the choice of the optimal therapeutic strategy. The incidence of CP is increasing worldwide, which occurs partly due to the improvement of diagnostic methods that allow detecting the disease at earlier stages. Current article discusses the key methods of diagnosis and therapy of the disease, developed on the basis of the analysis of the results of performed studies and observations, their advantages and disadvantages. Actual diagnostics of CP should include a full range of necessary examination methods, which helps to choose the best treatment approach and helps to control the course of the disease.

Overactive urinary bladder (OAUB) is a widespread medical and social problem that significantly impairs life quality of the patients. Taking into account the diversity of etiology and pathogenesis of this clinical syndrome, its correction requires a multidisciplinary approach involving doctors of various specialties, and in many cases, therapists and general practitioners can provide necessary assistance to patients. The key place in OAUB treatment strategy is occupied by medicamentous therapy, where first-line drugs are remedies with M-anticholinergic effect. Peculiarities of pharmacokinetics and pharmacodynamics of trospium chloride favorably distinguish it from other representatives of this pharmacotherapeutic group. Due to its hydrophilicity, it does not penetrate the blood-brain barrier and does not have adverse effects on the central nervous system and cognitive functions. Numerous clinical studies have confirmed the high efficacy and safety of trospium chloride in complex clinical cases associated with comorbidity and neurogenic urination disorders.

Osteoarthritis (OA) is one of the most common rheumatic diseases, in which low-grade inflammation plays a significant role, affecting all structural elements of the joint and leading to the degradation of its tissues. To reduce inflammation with nonsteroidal anti-inflammatory drugs (NSAIDs) can be difficult for a number of objective reasons, the most important of which are poor penetration of systemic NSAIDs into avascular joint tissues and limited possibilities of using these drugs in patients with comorbid diseases. In this regard, the most promising way of reducing inflammation (pain) and the rate of joint tissue degeneration is intra-articular introduction of hyaluronic acid (HA), which, according to international and Russian sources, is characterized by efficacy in a large number of patients with OA, including those having initial stages of pathological process. At the same time, HA administered locally demonstrates high safety comparatively to drugs used orally. Modified structure of HA and modern buffers for intra-articular introduction provide a higher concentration of the medicine in the joint, helping to provide a long-term analgesic and structure-modifying effect. Intra-articular administration of HA can be an effective therapeutic measure both at an advanced and early stage of OA of the knee joint.