Rheumatology

 

Асфандиярова, Н. С. Псориатический артрит (обзор литературы) / Н. С. Асфандиярова, Р. Р. Шилин // Клиницист. – 2024. – Т. 18, № 3. – С. 10–20.

(Psoriatic arthritis (literature review))

 Psoriatic arthritis (PsA) is a chronic immune-inflammatory progressive disease of the musculoskeletal system observed in psoriasis, which affects the joints, spine and entheses; it occurs in the form of arthritis, dactylitis, enthesitis, and can also manifest as spondylitis or sacroiliitis. The etiology of PsA is unknown, but the pathogenesis has been studied in more detail. Under the influence of external factors, such as infectious agents (viruses, bacteria, fungi), neuropsychic stress, injuries, drugs, changes in intestinal microbiota, etc., genetically predisposed individuals experience activation of the immune system, both congenital and acquired. Currently, there are 5 clinical forms of PsA: predominantly lesion of the distal interphalangeal joints of the hands and feet, distal form; mutilating arthritis; psoriatic spondylitis; asymmetric mono-oligoarthritis; symmetrical polyarthritis, rheumatoid-like form. Along with the characteristic symptomsof skin and joint damage, patients with PsA note a decrease in the quality of life, general malaise, fever, enlarged lymph Review nodes, weight loss, signs of comorbid pathology (obesity, diabetes, cardiovascular diseases). Arthritis is accompanied by tendinitis, synovitis, enthesitis. Isolated spinal damage (psoriatic spondylitis) is rare, it is usually combined with peripheral arthritis, characterized by pain in the spine, dysfunction, curvature. Differential diagnostics are carried out with rheumatoid arthritis, gout, ankylosing spondylitis, polyosteoarthritis, infectious forms of joint damage, joint damage in chronic inflammatory bowel diseases. Treatment of PsA should include medication, physiotherapy and spa treatment. Usually, treatment of PsA begins with the use of such drugs as methotrexate, leflunomide, sulfasalazine, cyclosporine A; non-steroidal anti-inflammatory drugs and intra-articular administration of glucocorticosteroids are used as an auxiliary agent, they are classified as symptom-modifying drugs, they partially improve the patient’s quality of life, reduce pain, but have little effect on the progression of the pathological process. In the absence of an effect from previously conducted treatment and contraindications, genetically engineered biological drugs are used.
Авдеева, А. С. Нетоз нейтрофилов: методы лабораторной оценки и роль в патогенезе иммуновоспалительных ревматических заболеваний (обзор литературы) / А. С. Авдеева, А. П. Алексанкин // Клиническая лабораторная диагностика. – 2024. – Т. 69, № 5. – С. 206–214.

(NETosis: Assessment Methods and Role in the Pathogenesis of Systemic Autoimmune Rheumatic Diseases (Review of Literature))

 Neutrophil granulocytes are the most numerous group of myeloid cells that provide protection to the body by producing reactive oxygen and chlorine species, phagocytosis of pathogens and dead cells, production of chemokines and cytokines, and release of NETs (Neutrophil Extracellular Traps), consisting of chromatin and granules , capable of binding and destroying microorganisms. In systemic autoimmune rheumatic diseases (SARDs), the formation of NETs leads to damage to organs and tissues, which is accompanied by inflammation and thrombus formation. This process is caused by the release of a large number of proteins and enzymes that activate macrophages and lymphocytes, as well as autoantigens, which stimulates the formation of autoantibodies. Increased production of myeloperoxidase (MPO) and proteinase 3 (PR-3) is important in the pathogenesis of systemic vasculitis, nucleic acids and DNA molecules are autoantigens in systemic lupus erythematosus (SLE), citrullinated histones can be considered as neoepitopes that cause
the formation of antibodies to citrullinated proteins (ACPA) in rheumatoid arthritis (RA). Netosis can be caused by antibodies, immune complexes, cytokines, chemokines, and microcrystals. Currently, two fundamentally different forms of NETosis have been described: classic or suicidal NETosis, which leads to cell death, and intravital or vital, in which the cell does not die and retains many effector functions.
Considering the large contribution of NETosis in the pathogenesis of SARDs, practical issues of assessing NETosis in various groups of patients are widely discussed in the literature. Methods include microscopy, enzyme-linked immunosorbent assay of NET products, and multicolor flow cytometry, which allows the identification of the main components of NETs in whole blood. This technique allows rapid and reliable assessment of several thousand cells per sample and is not subject to potential observer error, two major limitations of microscopic quantification. The use of cytometry facilitates the direct in vivo detection of circulating NETs in blood samples. The purpose of the publication is to summarize and analyze the most important studies concerning the role of neutrophil NETosis in the pathogenesis of SARDs, and also to discuss promising directions for laboratory diagnosis of NETosis. An exhaustive search was conducted in MEDLINE databases (via PubMed), using MESH (medical subject headings) terminology and keywords, including rheumatoid arthritis, systemic lupus erythematosus, systemic vasculitides, disease pathogenesis, NETosis, multicolor flow cytometry, microscopy, enzyme-linked immunosorbent assay.
Каратеев, А. Е. Трудный для лечения остеоартрит – обоснование для мультимодальной тактики лечения / А. Е. Каратеев // Современная ревматология. – 2023. – Т. 17, № 6. – С. 128–135.

(Difficult-to-treat osteoarthritis – justification for multimodal treatment tactics)

 Effective pain control is the most important clinical task in the treatment of osteoarthritis (OA). The International Expert Council, which discussed the possibility of introducing the principle of “treatment to target” to OA treatment, recognized the PASS (patient acceptable symptoms state) index as the most reasonable criterion for the successful treatment of this disease. However, according to several population studies, it is not possible to achieve a significant improvement in OA in 20–30% of patients. Factors that may be responsible for an inadequate response to the treatment of OA are severe structural changes in the joints, dysfunction of the nociceptive system (neuroplastic changes, central sensitization), psychoemotional disorders and comorbid pathologies. Therefore, the choice of therapeutic tactics in patients with OA who have moderate or severe pain should be individualized and take into account the phenotype of the disease, the characteristics of the clinical situation and the presence of comorbid pathologies. Leading experts in OA believe that the most rational approach to the management of this disease is a multidisciplinary, multimodal treatment that includes the complex use of nonsteroidal anti-inflammatory drugs, local injection therapy, Symptomatic Slow Acting Drugs for Osteoarthritis (SYSADOA) and non-pharmacological approaches. There is currently a strong evidence base confirming the efficacy and safety of SYSADOA (particularly the combination of glucosamine and chondroitin). This allows us to consider SYSADOA as a mandatory component of OA treatment, regardless of stage, phenotype and concomitant pathology. A new direction of OA therapy is the use of native (undenatured) collagen preparations, the effect of which is associated with the formation of immunological tolerance to autoantigens of this protein and a reduction in the severity of chronic joint inflammation. Several clinical studies have confirmed the effectiveness of native collagen supplements. The appearance of a new dietary supplement containing native collagen, glucosamine, chondroitin, B vitamins and ginger extract expands the possibilities of pharmaconutraceutical support for patients with OA.
Бекетова, Т. В. Моногенные аутовоспалительные синдромы с чертами системных васкулитов: новая область ревматологии / Т. В. Бекетова, М. Ф. Бекетова, Е. Л. Насонов // Научно-практическая ревматология. – 2023. – Т. 61, № 4. – С. 458–465.

(Monogenic Autoinflammatory Syndromes with Features of Systemic Vasculitis: A New Field of Rheumatology)

 The article is dedicated to a new actual problem in rheumatology: vasculitis and vasculitis-like manifestations in monogenic autoinflammatory syndromes in adult. The features of the clinical course of the rarely diagnosed VEXAS syndrome, as well as the SAVI and COPA syndromes, which sometimes occur in adults, are considered. Promising directions of future treatment are discussed
Волчаночный нефрит – современные аспекты диагностики и терапии. Часть I / С. К. Соловьев [и др.] // Научно-практическая ревматология. – 2024. – Т. 62, № 1. – С. 55–64.

(Lupus nephritis – modern aspects of diagnosis and therapy. Part I)

 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.
Ризатдинова, Ф. Н. Псориатический артрит и сердечно-сосудистые заболевания / Ф. Н. Ризатдинова, Д. И. Абдулганиева // Практическая медицина. – 2023. – Т. 21, № 3. – С. 32–39.

(Psoriatic arthritis and cardiovascular disease)

 Psoriatic arthritis (PsA) is a chronic autoimmune disease that increases the risk of cardiovascular diseases (CVD) such as myocardial infarction, stroke, arrhythmias, and conduction disorders. Traditional risk factors such as hypertension, dyslipidemia, and obesity may only partly explain the increased risk. Many factors, including chronic inflammation, metabolic syndrome, autonomic dysfunction, and endothelial dysfunction, may play a role in increasing the risk of CVD. PsA is associated with direct myocardial damage, left ventricular remodeling, electrocardiographic abnormalities, and arrhythmias, including fetal ones. This review considers the main CVDs, risk factors, the mechanisms of influence of PsA and its activity and phenotypes on these risk factors, as well as the possible interventions to reduce the risk of CVD in patients with PsA.
Файрушина, И. Ф. Роль капилляроскопии в оценке микроваскуляризации при ревматических заболеваниях / И. Ф. Файрушина // Практическая медицина. – 2023. – Т. 21, № 3. – С. 40–43.

(Role of nailfold capillaroscopy in assessing microvasculature in rheumatic disease)

 Nailfold capillaroscopy (NFC) is a non-invasive and safe tool for microvasculature assessment. Since its recent inclusion to classification criteria for systemic sclerosis (American College of Rheumatology (ACR) / European League Against Rheumatism (EULAR), 2013) and monitoring disease progression, the importance of NFC in rheumatology has increased. Given its growing use by a variety of physicians worldwide, both in daily practice to differentiate primary and secondary Raynaud’s syndrome, and in the context of research to predict the progression of the disease and evaluate the treatment effectiveness, the description of the acquisition and analysis of capillaroscopic images remains relevant. This report provides information on the interpretation of NFC changes, particularly in systemic sclerosis and other rheumatic diseases.
Лекарственно-индуцированная красная волчанка / Е. И. Хадыева [и др.] // Практическая медицина. – 2023. – Т. 21, № 3. – С. 44–47.

(Drug-induced lupus erythematosus)

 This article presentsa clinical case in which a patient observed by neurologists with a diagnosis of neuropathy and treated with anticonvulsants and antidepressants developed new clinical manifestations and laboratory changes characteristic of systemic lupus erythematosus. A clinical version emerged that the neurological changes were the disease onset, followed by the development of the remaining clinical and laboratory symptoms (the diagnosis fully met the 2019 EULAR criteria -a score of 16 points, 10 points are sufficient to make a diagnosis). However, after a very short and low-dose therapy with methylprednisolone and hydroxychloroquine and withdrawal of anticonvulsants, there was a rapid recovery of specific antibodies and improvement of clinical symptoms, which allowed assuming drug-induced lupus erythematosus in this patient. Currently, the list of drugs that can cause this problem includes more than 100 drugs.