Vol 98, No 5 (2026): Issues of rheumatology

The problem of osteoarthritis (OA) in patients with atopy (bronchial asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis) discussed. In patients with atopy, the risk of OA is significantly higher (36–58%) than in the general population. Possible mechanisms of OA in atopy are considered. Further research may help decipher the pathogenesis of OA and improve pharmacotherapy.

Aim. To investigated the impact of the new hemodynamic definition of pulmonary arterial hypertension (PAH) as proposed by the 6th PH World Symposium on the phenotypes, outcome and survival in patients with systemic sclerosis (SSc).

Materials and methods. We retrospectively analyzed consecutive SSc patients included in our Center for a first right-heart catheterization between 2011 and 2019. The association between hemodynamics’ phenotype and outcome and survival was studied.

Results. We included 33 SSc patients, who had a high risk of PAH development with mPAP< 25 mmHg and 7 with early PAH I–II FC. Among them, 6 had a baseline mPAP value between 21 and 24 mmHg and PVR≥2 mmHg without interstitial lung disease and left heart disease, and were reclassified as PAH; only 1 of which raised their mPAP≥25 mmHg during 123 months follow-up. In 18 patients with mPAP< 20 mmHg; 1 of which raised their mPAP≥25 mmHg during 157 months follow-up. In 8 patients with unclassified PH mPAP didn’t raise during 123 months of follow-up. The 5-year survival rate was 83% in the group with unconfirmed PH, 100% in the group with unclassified PH, and 88% in those with early PAH. With classical PAH-SSс I–II FC, according to the old hemodynamic criteria, the 5-year survival rate was 100%. No significant differences were found. There were also no differences in survival during the entire follow-up period. We did not observed relation between mPAP, PVR and outcome and mortality.

Conclusion. Among patients with the PAH phenotype of SSc who do not have interstitial lung disease or left heart disease, those with early PAH can be found, although the frequency and rate of progression to classical PAH at these stages are very slow.

Background. Psoriatic arthritis (PsA) exhibits the greatest predisposition to the development of metabolic disorders compared to other inflammatory joint diseases, including those with a high risk of type 2 diabetes mellitus (T2DM).

Aim. To study the clinical and imaging characteristics of patients with PsA depending on the presence of DM.

Materials and methods. This retrospective study included 309 patients (219 men and 90 women) with PsA. Patients were divided into subgroups based on the presence or absence of T2DM. A comparative analysis of quantitative and qualitative indicators, as well as a correction analysis, was conducted.

Results. The proportion of patients with diabetes in the study sample was 13.9%. Patients with concomitant T2DM were characterized by a less frequent presence of advanced stages of sacroiliitis, but more often had a higher BASDAI index (Bath Ankylosing Spondylitis Disease Activity Index) (6.4±1.9 vs 5.4±1.5; p< 0.001), as well as a greater number of painful joints (13.0 [7.3; 20.0] vs 7.0 [3.0; 15.0]; p=0.01) and erythrocyte sedimentation rate level (25.0 [16.0; 40.0] vs 16.0 [6.0; 34.0]; p=0.02), more often had nail psoriasis, and were characterized by more advanced stages of functional impairment. Patients with T2DM were more likely to be currently receiving methotrexate, sulfasalazine, leflunomide, and nonsteroidal anti-inflammatory drugs, and were also more likely to have a history of intra-articular glucocorticoid administration with a comparable history of anti-cytokine therapy. Furthermore, patients with T2DM were more likely to be obese (25.0% vs 8.24%; p< 0.001) and have cardiovascular disease (72.09% vs 27.82%; p< 0.001).

Conclusion. The presence of diabetes was associated with higher PsA activity and radiographic progression.

Aim. To describe a Russian cohort of patients with IgG4-related retroperitoneal fibrosis (RPF).

Materials and methods. This retrospective single-center study included 36 patients diagnosed with IgG4-related RPF according to the revised 2020 diagnostic criteria. Clinical, laboratory, instrumental, and pathomorphological data were analyzed.

Results. The cohort of 36 patients with IgG4-related RPF predominantly comprised males (4:1 ratio), with a median onset age of 52 years and median time to diagnosis of 8 months. The disease most presented with low back or lower abdominal pain (75%), renal dysfunction (44%), elevated serum IgG4>1.35 g/L (82%), and increased ESR/CRP. Urinary tract infection was detected in 44% due to frequent ureteral catheterization. Isolated retroperitoneal involvement occurred in 72% of cases, with typical infrarenal periaortitis in 58%; atypical sites included perirenal, periureteral, and presacral localizations. Biopsy (n=23) revealed lymphoplasmacytic infiltrate (100%), fibrosis (87%), IgG4+/CD138+>40% (71%), with obliterative phlebitis (26%) and tissue eosinophilia (26%) less common.

Conclusion. Compared to international data, our findings reveal a higher prevalence of atypical localizations and concomitant urinary tract infections, necessitating their consideration in diagnostic algorithms and treatment planning for RPF patients.

The article describes a clinical case of a patient, at first glance healthy from the cardiovascular side, whose only complaint was ventricular extrasystole during exacerbations of arthritis. A typical scenario of such patients management is the suppression of the rheumatoid arthritis activity with the expectation that the involvement of target organs will subside accordingly. A rheumatoid nodule – specific manifestation of rheumatoid arthritis in the heart, that is usually detected in postmortem examinations and rare – according to echocardiography. Despite its small size (1.5×2 mm), the granuloma was the first clue to the patient’s hidden heart condition. Further investigations revealed potential „killers“ such as postinflammatory myocardial fibrosis, malignant ventricular arrhythmias, and coronary heart disease, prompting preventive measures. The case serves as an example of how, by pulling on the thread of a „clinically insignificant“ finding, it is possible to identify a slowly progressing life-threatening pathology. The discussion of the case demonstrates an algorithm for making decisions about the management of cardiac arrhythmias in patients with rheumatic pathology, based on modern research methods and understanding of the complex mechanism of arrhythmias in inflammatory cardiomyopathy.

The relationship between hyperuricemia and mitochondrial dysfunction remains poorly described in literature, despite its important clinical significance. The aim of this review is to identify the causes and mechanisms of uric acid's influence on the development of mitochondrial dysfunction. This review presents a comprehensive analysis of the pathogenetic relationship between uric acid (UA) and mitochondrial dysfunction as an evolutionarily formed process aimed at maintaining cellular energy homeostasis in conditions of energy deficiency, but modified into a pathological process in modern conditions of over-nutrition. The important role of the metabolism of fructose and its metabolite, UA, in the regulation of the energy balance of the cell is analyzed. The mechanisms of increased oxidative stress caused by UA and their effect on mitochondrial function have been determined. The important role of AMP-activated protein kinase (AMPK), a key regulator of cellular homeostasis, is analyzed, the inhibition of which by UA leads to mitochondrial dysfunction.

The article describes the history of the formation and development of scientific medical societies in Russia, with particular attention to the development of the Moscow Scientific Society of Cardiology.