卷 97, 编号 5 (2025): Issues of rheumatology

The progress achieved in deciphering the pathogenetic mechanisms of immune-mediated inflammatory rheumatic diseases (IIRDs) served as the basis for the development at the beginning of the 21st century of more than 20 bioligical agents, which are monoclonal antibodies or recombinant proteins that block the activity of proinflammatory cytokines and/or pathological activation of immune system cells, and in recent years, a group of synthetic targeted anti-inflammatory drugs that modulate the signaling of cytokines involved in the development of inflammation, primarily Janus kinase inhibitors. The article will focus primarily on the achievements of pharmacotherapy of inflammatory rheumatic diseases, considered as models for studying the fundamental mechanisms of immunopathology of human diseases and the development of new approaches to anti-inflammatory therapy, with an emphasis on the contribution of Russian rheumatology and pharmacology to the study of this problem.

Background. Pathogenesis of ankylosing spondylitis (AS) is based on long-term chronic inflammation, which can lead to the development of secondary amyloidosis.

Aim. To analyze the frequency of secondary amyloidosis in a hospital cohort of patients with AS and describe their clinical and laboratory features.

Materials and methods. Four hundred and fifty eight patients with AS were examined. Patients’ disease activity and functional status were assessed according to the Russian expert recommendations. Additionally, in all patients, SAA in blood serum was determined using nephelometric method. Patients having high laboratory activity during several years underwent fibrogastroduodenoscopy and biopsy of the duodenum submucosal layer, in the absence of contraindications.

Results. Among 458 patients with AS, the diagnosis of AA amyloidosis was confirmed in 21 (4.5%) cases; the frequency among men was 5.6%, among women – 2.6%. In 15 (3.3%) cases, AA amyloidosis was diagnosed for the first time, and only in 6 (1.3%) patients it was diagnosed before. Patients with AA-amyloidosis had higher disease activity measured by ASDAS-CRP and higher ESR values. Patients with amyloidosis had higher frequency of syndesmophytes and they underwent joint arthroplasty more often compared to the control group. Among the patients with amyloidosis, a significant negative association was revealed between the patients’ age of enrollment in the study and the presence of arthritis, the values of BASDAI and ASDAS indices. The following associations were not observed in the control group. We did not find the expected association between SAA and activity scores, these values did not differ between groups.

Conclusion. In a specialized rheumatology department, the frequency of AA-amyloidosis in patients with AS reaches 4.5%. Amyloidosis significantly more often develops in males, in patients with juvenile onset, in the late stage of the disease, in patients with high disease activity. Without a targeted search for secondary amyloidosis in patients with AS, its detection rate in real clinical practice is about 30%.

Aim. To study the association of uric acid (UA) levels with skeletal muscle mass, strength and physical performance in women with rheumatoid arthritis (RA).

Materials and methods. One hundred thirty women (median age 61 [53; 66] years) with confirmed RA who signed informed consent were examined. A clinical and laboratory examination was performed, including an assessment of muscle strength, physical performance. Dual-energy X-ray absorptiometry according to the “whole body” program was done.

Results. The median UA level was 262.8 [197.4; 310.5] μmol/l, the incidence of hyperuricemia was 9.2%. Positive correlations of UA with the total lean mass index (r=0.32; p<0.001), appendicular lean mass index (r=0.24; p=0.006) were established. These associations were confirmed in multiple linear regression analysis (b*=0.38; p<0.001 and b*=0.29; p<0.001, respectively). There was no association between the level of UA and RA parameters (duration of the disease, glucocorticoid intake, RF and ACCP seropositivity, ESR, CRP and DAS-28 index), as well as with muscle strength. A negative correlation between the level of UA and parameters of physical performance was found.

Conclusion. The frequency of hyperuricemia was 9.2% in women with RA. Multiple regression analysis confirmed an independent association between lean mass and UA level.

Aim. The objectives of the study: to conduct serologic screening for latent HBV infection in rheumatoid arthritis (RA) patients, to determine the level of protective antibodies to HBsAg in RA patients, and to determine the clinical and laboratory features of RA patients with latent hepatitis B in the course of retrospective analysis.

Materials and methods. 440 HBsAg-negative RA patients over 18 years old were included in the study. Blood serum was analyzed for the presence of antibodies to HBcAg (anti-HBc) by semi-quantitative method and the content of antibodies to HBsAg by quantitative method. Patients were included in the study consecutively, the inclusion criterion was negative HBsAg test, the exclusion criteria were co-infection with hepatitis C virus or HIV.

Results. It was found that 64 (14%) patients were anti-HBs positive, in this group more than half [39 (61%)] had no antibodies to HBsAg (anti-HBs) in protective titer (more than 10 IU/mL), and 26 patients had no anti-HBs at all. Overall, only 130 (30%) patients in the cohort had anti-HBs in protective titer. Retrospective analysis of case histories and outpatient records revealed 33 cases of transaminase elevation, and in 15 patients this adverse event was the cause of antirheumatic drug withdrawal. Clinically significant thrombocytopenia occurred in 10 patients.

Conclusion. Extended HBV screening for RA patients showed the absence of anti-HBV protection in 70% of patients. Latent HBV [HBsAg(-)/anti-HBc(+)] was detected in 14% of patients. It is necessary to be alert to cases of combined elevation of ALT and/or AST and thrombocytopenia as symptoms of probable exacerbation of HBV infection.

Obesity is considered the most important risk factor for the development of osteoarthritis (ОА) – progressive inflammatory disease of the joints, that is one of the causes of disability and long-term immobilization. Excessively developed adipose tissue not only increases the mechanical load on the joints, but also participates in the maintenance of chronic low-grade inflammation through the production of adipokines, cytokines, hemokines, complement factors and hormones. Adipokines influence cells of synovial tissue, cartilage and bone, which in turn produce some adipokines locally, maintaining an inflammatory microenvironment intraarticularly. Adipokines, including leptin, adiponectin, chemerin, and resistin, regulate inflammatory immune responses in cartilage, also affecting synovial tissue cells and bone. In turn, chondrocytes, osteoblasts and osteoclasts produce some adipokines locally, maintaining an inflammatory microenvironment intra-articularly. Weight loss in OA can improve the patient's quality of life, physical function, lead to reduce pain, and slow or halt the progression of structural degenerative changes. The purpose of this article is to clearly describe the pathogenetic ways between obesity and inflammation, to reveal the mechanisms of the pathological state of adipokines and proinflammatory mediators (IL-6, TNF-á, etc.) on cartilage and bone homeostasis and, as expected, to evaluate their participation in the development of OA. So understanding immune regulation and resolution of inflammation in obesity is critical to developing treatments approaches to OA for these patients. The article also analyzes current researches on the effect of drug therapy (liraglutide, orlistat, sibutramine) and bariatric surgery of obesity on the course of inflammatory joint diseases.

Aim. To systematize data on the trends of the prevalence of Helicobacter pylori infection among the Moscow adult population.

Materials and methods. The MEDLINE/PubMed, EMBASE, Google Scholar, and the Russian Science Citation Index were searched for studies published between January 1, 1985, and February 7, 2025, inclusive. Publications were selected based on an analysis of their titles and abstracts. Included were peer-reviewed publications in Russian and English containing data on the prevalence of H. pylori among the adult population of Moscow, studies using validated methods for the diagnosis of H. pylori based on serological, urease respiratory tests, histological and molecular methods, as well as publications containing detailed statistical processing of data suitable for inclusion in the meta-analysis.

Results. The final analysis included seven studies totaling 7,581 subjects (the overall mean age of all subjects was 48.28±13.20 years). The overall prevalence of H. pylori infection in the adult population of Moscow in the analyzed pool of studies for 18 years (2006–2024) was 66.534% (95% confidence interval [CI] 42.097–86.989), including 78.661% (95% CI 59.400–92.910) when using serological diagnostic methods and 48.473% (95% CI 32.331–64.781) when using the ¹³C-urease respiratory test. Studies conducted before 2015 showed the prevalence of H. pylori infection of 81.294% (95% CI 67.202–92.109), 68.028% (95% CI 29.383–95.895) in 2015–2020, and 39.860% (95% CI 33.993–45.877) after 2020. The meta-regression analysis revealed a statistically significant decrease in the prevalence of H. pylori depending on the year of the study (regression coefficient for the year -4.22 (95% confidence interval -6.27–-2.17; p<0,0099).

Conclusion. The meta-analysis showed a gradual regression in the prevalence of H. pylori infection in Moscow, the largest metropolis in Russia and Europe. However, infection prevalence in the adult population remains relatively high, supporting the need for continued programs of timely diagnosis of H. pylori and subsequent eradication therapy to reduce the risk of associated diseases.

Relapsing polychondritis is a systemic disease characterized by inflammation of cartilage and proteoglycan-rich tissues leading to progressive deformity and dysfunction of the involved structures. Ear and nasal chondritis and/or polyarthritis are the most common clinical forms of the disease (80%), but all types of cartilage can potentially be involved. Due to the polymorphic nature of the disease, the diagnosis of relapsing polychondritis often remains unclear due to non-specific symptoms. In this article, we offer a clinical observation of this disease.

The article is dedicated to the memory of the outstanding Russian internist and scientist, academician of the Russian Academy of Medical Sciences – E.M. Tareev, who had a huge influence on the development of Russian medicine. The life and professional path of the scientist, his most significant scientific achievements in various areas of internal pathology, marked by high state awards and prestigious national prizes, are presented. The basic principles of the scientific school of E.M. Tareev are also presented, including his statements on the importance of maintaining at the present stage a broad general therapeutic approach to solving complex integrated tasks of health care.