Pub Date : 2023-06-28DOI: 10.47360/1995-4484-2023-276-291
E. Nasonov, A. Avdeeva, D. Dibrov
Rheumatoid arthritis (RA) is the most common immune mediated (autoimmune) rheumatic disease, manifested by chronic erosive arthritis and systemic internal organ damage. Currently, RA is considered as a syndrome characterized by clinical and pathogenetic heterogeneity associated with a variety of mechanisms of pathological activation of innate and acquired immunity, determining the variability of the course and outcome of the inflammatory process and effectiveness of therapy. Based on the detection or absence of rheumatoid factor (RF) IgM and antibodies to cyclic citrullinated peptides (ACCP), RA can be conventionally divided into two subtypes (phenotypes): seropositive RA and seronegative RA, but thanks to improvement of laboratory diagnostic methods the spectrum of autoantibodies detected in RA has increased significantly. Diagnosis of seronegative RA based on classification (rather than diagnostic) criteria can be difficult, especially in the early stages of the disease, and the diagnosis is made only during long-term follow-up of patients. It complicates the timely prescription of adequate anti-inflammatory therapy. This article summarizes the data on genetic predisposition, immunopathogenesis, biomarkers, clinical spectrum, instrumental diagnosis and pharmacotherapy of seronegative RA.
{"title":"Rheumatoid arthritis as a clinical and immunological syndrome: focus on the seronegative subtype of the disease","authors":"E. Nasonov, A. Avdeeva, D. Dibrov","doi":"10.47360/1995-4484-2023-276-291","DOIUrl":"https://doi.org/10.47360/1995-4484-2023-276-291","url":null,"abstract":"Rheumatoid arthritis (RA) is the most common immune mediated (autoimmune) rheumatic disease, manifested by chronic erosive arthritis and systemic internal organ damage. Currently, RA is considered as a syndrome characterized by clinical and pathogenetic heterogeneity associated with a variety of mechanisms of pathological activation of innate and acquired immunity, determining the variability of the course and outcome of the inflammatory process and effectiveness of therapy. Based on the detection or absence of rheumatoid factor (RF) IgM and antibodies to cyclic citrullinated peptides (ACCP), RA can be conventionally divided into two subtypes (phenotypes): seropositive RA and seronegative RA, but thanks to improvement of laboratory diagnostic methods the spectrum of autoantibodies detected in RA has increased significantly. Diagnosis of seronegative RA based on classification (rather than diagnostic) criteria can be difficult, especially in the early stages of the disease, and the diagnosis is made only during long-term follow-up of patients. It complicates the timely prescription of adequate anti-inflammatory therapy. This article summarizes the data on genetic predisposition, immunopathogenesis, biomarkers, clinical spectrum, instrumental diagnosis and pharmacotherapy of seronegative RA.","PeriodicalId":21518,"journal":{"name":"Rheumatology Science and Practice","volume":"201 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73757585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.47360/1995-4484-2023-292-297
Т.М. Решетняк, Н М Кошелева, Евгений Львович Насонов, T. Reshetnyak, N. Kosheleva, E. L. Nasonov, V. A. N. Research, Магомедалиевна
Systemic lupus erythematosus (SLE) is a disease of women of reproductive age. Up to a certain time, pregnancy was contraindicated in patients with SLE, improving the management of the disease itself (monitoring), as well as understanding the safety of drugs make pregnancy possible for most patients with SLE. Careful pregnancy planning is crucial when the disease is well controlled with pregnancy-compatible medications. This is also facilitated by the management of patients jointly by doctors of different specialties (rheumatologist, neurologist, endocrinologist, etc.) with obstetricians. The article discusses the achievements of managing women with SLE during pregnancy planning, during pregnancy and after delivery.
{"title":"Systemic lupus erythematosus and pregnancy: Before gestation, during and after childbirth","authors":"Т.М. Решетняк, Н М Кошелева, Евгений Львович Насонов, T. Reshetnyak, N. Kosheleva, E. L. Nasonov, V. A. N. Research, Магомедалиевна","doi":"10.47360/1995-4484-2023-292-297","DOIUrl":"https://doi.org/10.47360/1995-4484-2023-292-297","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a disease of women of reproductive age. Up to a certain time, pregnancy was contraindicated in patients with SLE, improving the management of the disease itself (monitoring), as well as understanding the safety of drugs make pregnancy possible for most patients with SLE. Careful pregnancy planning is crucial when the disease is well controlled with pregnancy-compatible medications. This is also facilitated by the management of patients jointly by doctors of different specialties (rheumatologist, neurologist, endocrinologist, etc.) with obstetricians. The article discusses the achievements of managing women with SLE during pregnancy planning, during pregnancy and after delivery.","PeriodicalId":21518,"journal":{"name":"Rheumatology Science and Practice","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74353858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.47360/1995-4484-2023-307-319
A. A. Baranov, I. Vinogradova, O. Anoshenkova, O. Antipova, E. Bogdanova, Y. Y. Grabovetskaya, E. Ilivanova, A. Kalyagin, I. Kushnir, N. Lapkina, M. V. Mokrousova, O. Nesmeyanova, N. M. Nikitina, P. Shesternya, N. Yudina, E. Feist, E. Nasonov
Aim. Switching to another biologic with the same mode of action provides greater opportunity for long-term management of patients with rheumatoid arthritis (RA). In clinical practice, especially in the context of the COVID-19 pandemic, such switching occurred for non-medical reasons as well. However, there is no information about switching from interleukin 6 (IL-6) receptor (R) inhibitor to direct IL-6 inhibitor. Objective – to assess the efficacy and safety of therapy in RA patients, after switching from IL-6R inhibitors (tocilizumab (TOC), sarilumab (SAR)) to olokizumab (OKZ) for reasons not related to the loss of their efficacy or adverse events. Material and methods. In this retrospective cohort study efficacy parameters and routine biochemical data were analyzed using descriptive statistics – mean values with standard deviation for continuous parameters and absolute and relative frequency for binary variables. Adverse events (AE) were reported according to patient’s files. The statistical significance and changes of the analyzed variables by visits were determined using paired t-test. Fisher’s exact test or chi-square test was used to compare the proportion of patients with improvement/no change and of patients with worsening. All tests were 2-sided, and p<0.050 was considered statistically significant. As this was an observational study, the statistical criteria have not been pre-specified. Results. We analyzed results obtained during 5 visits (2 visits before switching, switching visit and 2 visits after switching) in 110 RA patients who switched to OKZ 64 mg every 4 weeks subcutaneously (SC). Most patients (79.1%) were women, and 70% of patients were both positive by rheumatoid factor and antibodies to cyclic citrullinated peptide. Mean RA duration was 11 [6; 16] years, previous treatment duration was 44 [27; 62] months and mean interval before switching to OKZ was 35 [31; 68] days. This relatively long interval led to an increase in DAS28-ESR (Disease Activity Score 28 with determination of erythrocyte sedimentation rate) from 2.4 [1.9; 3.0] to 2.6 [2.1; 3.5] and DAS28-CRP (DAS28 with determination of C-reactive protein level) from 2.8 [2.0; 3.3] to 2.9 [2.2; 4.0] (the trends were similar in patients who received combined therapy and monotherapy). After switching, all of RA symptoms and indexes have been improved compared with the switching visit (some of them were significantly better even compared with stable therapy period e. g. DAS28-CRP was 2.4 [2.0; 3.1] in the overall group and 2.4 [2.1; 2.7] in the monotherapy group). AEs were registered in only 7 (6.4%) patients, of which 1 (0.9%) case (an exacerbation of herpes infection) was considered as serious. The most frequent AEs were arthralgia and mild transient leukopenia (2 patients each). There were no deaths. Conclusion. OKZ effectively maintained remission/low activity of RA after switching in both regimens: as add-on to disease modifying anti-rheumatic drugs and as monotherapy, a
{"title":"Management of patients with rheumatoid arthritis in real clinical practice: Switching from interleukin 6 receptor inhibitors to interleukin 6 inhibitor (olokizumab)","authors":"A. A. Baranov, I. Vinogradova, O. Anoshenkova, O. Antipova, E. Bogdanova, Y. Y. Grabovetskaya, E. Ilivanova, A. Kalyagin, I. Kushnir, N. Lapkina, M. V. Mokrousova, O. Nesmeyanova, N. M. Nikitina, P. Shesternya, N. Yudina, E. Feist, E. Nasonov","doi":"10.47360/1995-4484-2023-307-319","DOIUrl":"https://doi.org/10.47360/1995-4484-2023-307-319","url":null,"abstract":"Aim. Switching to another biologic with the same mode of action provides greater opportunity for long-term management of patients with rheumatoid arthritis (RA). In clinical practice, especially in the context of the COVID-19 pandemic, such switching occurred for non-medical reasons as well. However, there is no information about switching from interleukin 6 (IL-6) receptor (R) inhibitor to direct IL-6 inhibitor. Objective – to assess the efficacy and safety of therapy in RA patients, after switching from IL-6R inhibitors (tocilizumab (TOC), sarilumab (SAR)) to olokizumab (OKZ) for reasons not related to the loss of their efficacy or adverse events. Material and methods. In this retrospective cohort study efficacy parameters and routine biochemical data were analyzed using descriptive statistics – mean values with standard deviation for continuous parameters and absolute and relative frequency for binary variables. Adverse events (AE) were reported according to patient’s files. The statistical significance and changes of the analyzed variables by visits were determined using paired t-test. Fisher’s exact test or chi-square test was used to compare the proportion of patients with improvement/no change and of patients with worsening. All tests were 2-sided, and p<0.050 was considered statistically significant. As this was an observational study, the statistical criteria have not been pre-specified. Results. We analyzed results obtained during 5 visits (2 visits before switching, switching visit and 2 visits after switching) in 110 RA patients who switched to OKZ 64 mg every 4 weeks subcutaneously (SC). Most patients (79.1%) were women, and 70% of patients were both positive by rheumatoid factor and antibodies to cyclic citrullinated peptide. Mean RA duration was 11 [6; 16] years, previous treatment duration was 44 [27; 62] months and mean interval before switching to OKZ was 35 [31; 68] days. This relatively long interval led to an increase in DAS28-ESR (Disease Activity Score 28 with determination of erythrocyte sedimentation rate) from 2.4 [1.9; 3.0] to 2.6 [2.1; 3.5] and DAS28-CRP (DAS28 with determination of C-reactive protein level) from 2.8 [2.0; 3.3] to 2.9 [2.2; 4.0] (the trends were similar in patients who received combined therapy and monotherapy). After switching, all of RA symptoms and indexes have been improved compared with the switching visit (some of them were significantly better even compared with stable therapy period e. g. DAS28-CRP was 2.4 [2.0; 3.1] in the overall group and 2.4 [2.1; 2.7] in the monotherapy group). AEs were registered in only 7 (6.4%) patients, of which 1 (0.9%) case (an exacerbation of herpes infection) was considered as serious. The most frequent AEs were arthralgia and mild transient leukopenia (2 patients each). There were no deaths. Conclusion. OKZ effectively maintained remission/low activity of RA after switching in both regimens: as add-on to disease modifying anti-rheumatic drugs and as monotherapy, a","PeriodicalId":21518,"journal":{"name":"Rheumatology Science and Practice","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89094212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.47360/1995-4484-2023-298-306
R. A. Karateev
The involvement of the cardiovascular system is a typical manifestation of systemic lupus erythematosus (SLE), which determines the high level of mortality and disability of patients. A serious clinical problem is the development of heart failure (HF), which frequency in SLE is 3–4 times more than in the population. The development of this pathology is a complex process that occurs under the influence of systemic autoimmune inflammation and associated with heart damage (pericarditis, myocarditis, endocarditis, сcoronary artery disease, myocardial infarction), disorders of the cardiac conduction system (various arrhythmias), atherosclerosis, arterial hypertension, pulmonary hypertension, thrombosis against connected with bleeding disorders (especially associated with antiphospholipid syndrome), traditional risk factors, as well as the negative effect of anti-rheumatic therapy. Mostly HF in SLE occurs in a subclinical form with a preserved ejection fraction, and is detected using instrumental methods in more than 60% of patients. The management of patients with SLE and HF requires early diagnosis of this pathology, to do this, various diagnostic methods are used (particularly, echocardiography with speckle tracking imaging technique) and the identification of biomarkers such as NT-proBNP. HF therapy in SLE patients is based on the maximal reduction o f the activity of the disease due to rational pathogenetic therapy, also the control of traditional risk factors – antihypertensive therapy, the use of statins and the prevention of arterial and venous thrombosis.
{"title":"Cardiovascular manifestations of systemic lupus erythematosus: the significance of heart failure","authors":"R. A. Karateev","doi":"10.47360/1995-4484-2023-298-306","DOIUrl":"https://doi.org/10.47360/1995-4484-2023-298-306","url":null,"abstract":"The involvement of the cardiovascular system is a typical manifestation of systemic lupus erythematosus (SLE), which determines the high level of mortality and disability of patients. A serious clinical problem is the development of heart failure (HF), which frequency in SLE is 3–4 times more than in the population. The development of this pathology is a complex process that occurs under the influence of systemic autoimmune inflammation and associated with heart damage (pericarditis, myocarditis, endocarditis, сcoronary artery disease, myocardial infarction), disorders of the cardiac conduction system (various arrhythmias), atherosclerosis, arterial hypertension, pulmonary hypertension, thrombosis against connected with bleeding disorders (especially associated with antiphospholipid syndrome), traditional risk factors, as well as the negative effect of anti-rheumatic therapy. Mostly HF in SLE occurs in a subclinical form with a preserved ejection fraction, and is detected using instrumental methods in more than 60% of patients. The management of patients with SLE and HF requires early diagnosis of this pathology, to do this, various diagnostic methods are used (particularly, echocardiography with speckle tracking imaging technique) and the identification of biomarkers such as NT-proBNP. HF therapy in SLE patients is based on the maximal reduction o f the activity of the disease due to rational pathogenetic therapy, also the control of traditional risk factors – antihypertensive therapy, the use of statins and the prevention of arterial and venous thrombosis.","PeriodicalId":21518,"journal":{"name":"Rheumatology Science and Practice","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89646202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.47360/1995-4484-2023-268-275
А. Н. Куликов, Н.В. Муравьева, Б. С. Белов, С. И. Глухова, A. Kulikov, N. Muravyeva, B. Belov, S. Glukhova, V. A. N. Research, Белов Борис Сергеевич
The aim of the study was to assess the safety of the combined vector vaccine Gam-COVID-Vac (Sputnik V) and to determine the risk factors for the development of adverse events in patients with immuno-inflammatory rheumatic diseases (IIRD). Patients and methods. A single-stage study of patients with IIRD who were on inpatient treatment or who applied to the consultative and diagnostic center of the V.A. Nasonova Research Institute of Rheumatology was conducted, who received both components of the Sputnik V vaccine. The control group included immunized persons without IIRD. All participants were interviewed by a research doctor with filling out a unified questionnaire, additional information was obtained from medical documentation. Results. The study included 325 patients with IIRD and 138 healthy controls. After vaccination with the first component, the number of patients with IIRD, in whom the development of local and systemic adverse events (AEs) was noted, was significantly lower compared to the control (20.3% and 38.4% respectively; p<0.001). These differences also persisted after immunization with the second component (12.3% and 28.3% respectively, p<0.001). After complete vaccination, no AEs were documented in 40.3% of patients and 22.5% of the control group (p<0.001). Female sex and, possibly, methotrexate therapy increases the risk of developing local and systemic AEs on the first component of the vaccine, rituximab therapy - on the second. A lower incidence of AEs is typical for elderly patients, patients with a disease duration of more than 10 years and obesity. Exacerbation of IIRD was registered in 1 (0.3%) case, the occurrence of new autoimmune phenomena was not observed. Conclusions. According to the data obtained, the use of Gam-COVID-Vac (Sputnik V) in patients with IIRD is safe.
{"title":"The use of the combined vector vaccine GamCOVID-Vac (Sputnik V) in patients with immuno-inflammatory rheumatic diseases: safety issues-news","authors":"А. Н. Куликов, Н.В. Муравьева, Б. С. Белов, С. И. Глухова, A. Kulikov, N. Muravyeva, B. Belov, S. Glukhova, V. A. N. Research, Белов Борис Сергеевич","doi":"10.47360/1995-4484-2023-268-275","DOIUrl":"https://doi.org/10.47360/1995-4484-2023-268-275","url":null,"abstract":"The aim of the study was to assess the safety of the combined vector vaccine Gam-COVID-Vac (Sputnik V) and to determine the risk factors for the development of adverse events in patients with immuno-inflammatory rheumatic diseases (IIRD). Patients and methods. A single-stage study of patients with IIRD who were on inpatient treatment or who applied to the consultative and diagnostic center of the V.A. Nasonova Research Institute of Rheumatology was conducted, who received both components of the Sputnik V vaccine. The control group included immunized persons without IIRD. All participants were interviewed by a research doctor with filling out a unified questionnaire, additional information was obtained from medical documentation. Results. The study included 325 patients with IIRD and 138 healthy controls. After vaccination with the first component, the number of patients with IIRD, in whom the development of local and systemic adverse events (AEs) was noted, was significantly lower compared to the control (20.3% and 38.4% respectively; p<0.001). These differences also persisted after immunization with the second component (12.3% and 28.3% respectively, p<0.001). After complete vaccination, no AEs were documented in 40.3% of patients and 22.5% of the control group (p<0.001). Female sex and, possibly, methotrexate therapy increases the risk of developing local and systemic AEs on the first component of the vaccine, rituximab therapy - on the second. A lower incidence of AEs is typical for elderly patients, patients with a disease duration of more than 10 years and obesity. Exacerbation of IIRD was registered in 1 (0.3%) case, the occurrence of new autoimmune phenomena was not observed. Conclusions. According to the data obtained, the use of Gam-COVID-Vac (Sputnik V) in patients with IIRD is safe.","PeriodicalId":21518,"journal":{"name":"Rheumatology Science and Practice","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75156394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.47360/1995-4484-2023-339-348
L. Kondrateva, Y. Gorbunova, T. Panafidina, T. Popkova
Objective – to identify different phenotypes of overweight in women with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) based on body mass index (BMI) and serum leptin levels, as well as to determine the frequencies of various metabolic disorders, hypertension and cardiovascular complications in individual phenotypes. Material and methods. The study included 50 women with RA and 46 with SLE aged 18 to 65 years without a history of diabetes and fasting hyperglycemia. The concentration of leptin (ELISA), insulin (electrochemiluminescence analysis) was determined in all patients, and the HOMA-IR index was calculated. Hyperleptinemia was diagnosed at leptin concentrations >11,1 ng/ml, insulin resistance (IR) – at HOMA-IR values ≥2,77. Three main phenotypes of overweight were distinguished: “classic” (BMI≥25 kg/m2 + hyperleptinemia), “healthy” (BMI≥25 kg/m2 , without hyperleptinemia), “hidden” or “latent” (BMI<25 kg/m2 + hyperleptinemia), as well as “normal weight” (BMI<25 kg/m2 , without hyperleptinemia). Results. Patients with RA and SLE were similar in age (p=0.4), disease duration (p=0.2) and BMI (p=0.5). Hyperleptinemia was found in 46% of women with RA and 74% – with SLE (p=0.005), IR – in 10% and 22% of patients, respectively (p=0.2). The “classic” phenotype of overweight was diagnosed in 30%, “healthy” – in 8%, “hidden” – in 16% of cases with RA and in 44%, 0% and 30% of cases with SLE, respectively. IR was found in 3%, hypertension – in 6% of patients with “normal weight”. With the “classical” phenotype, IR (29%) and hypertension (66%) were more common than with “normal weight” (p<0.01 in all cases), with the “hidden” phenotype, significant differences were obtained only in hypertension frequency (45%; p=0.0012), but not IR (18%). 3 out of 4 women with a history of cardiovascular complications suffered from “classic” overweight, one patient had a “normal weight”. Conclusion. In women with SLE up to 65 years of age, the frequency of hyperleptinemia, but not IR, is higher than in patients with RA. In both diseases, the “classic” overweight phenotype is most common. In RA, a “hidden” phenotype was detected less often than in SLE, at the same time, a “healthy” phenotype is not characteristic of SLE. The frequencies of metabolic disorders and hypertension is low with the “normal weight” and “healthy” phenotype, high – with the “classic”, intermediate – with the “hidden” phenotype.
{"title":"Hyperleptinemia as a marker of various phenotypes of obesity and overweight in women with rheumatoid arthritis and systemic lupus erythematosus","authors":"L. Kondrateva, Y. Gorbunova, T. Panafidina, T. Popkova","doi":"10.47360/1995-4484-2023-339-348","DOIUrl":"https://doi.org/10.47360/1995-4484-2023-339-348","url":null,"abstract":"Objective – to identify different phenotypes of overweight in women with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) based on body mass index (BMI) and serum leptin levels, as well as to determine the frequencies of various metabolic disorders, hypertension and cardiovascular complications in individual phenotypes. Material and methods. The study included 50 women with RA and 46 with SLE aged 18 to 65 years without a history of diabetes and fasting hyperglycemia. The concentration of leptin (ELISA), insulin (electrochemiluminescence analysis) was determined in all patients, and the HOMA-IR index was calculated. Hyperleptinemia was diagnosed at leptin concentrations >11,1 ng/ml, insulin resistance (IR) – at HOMA-IR values ≥2,77. Three main phenotypes of overweight were distinguished: “classic” (BMI≥25 kg/m2 + hyperleptinemia), “healthy” (BMI≥25 kg/m2 , without hyperleptinemia), “hidden” or “latent” (BMI<25 kg/m2 + hyperleptinemia), as well as “normal weight” (BMI<25 kg/m2 , without hyperleptinemia). Results. Patients with RA and SLE were similar in age (p=0.4), disease duration (p=0.2) and BMI (p=0.5). Hyperleptinemia was found in 46% of women with RA and 74% – with SLE (p=0.005), IR – in 10% and 22% of patients, respectively (p=0.2). The “classic” phenotype of overweight was diagnosed in 30%, “healthy” – in 8%, “hidden” – in 16% of cases with RA and in 44%, 0% and 30% of cases with SLE, respectively. IR was found in 3%, hypertension – in 6% of patients with “normal weight”. With the “classical” phenotype, IR (29%) and hypertension (66%) were more common than with “normal weight” (p<0.01 in all cases), with the “hidden” phenotype, significant differences were obtained only in hypertension frequency (45%; p=0.0012), but not IR (18%). 3 out of 4 women with a history of cardiovascular complications suffered from “classic” overweight, one patient had a “normal weight”. Conclusion. In women with SLE up to 65 years of age, the frequency of hyperleptinemia, but not IR, is higher than in patients with RA. In both diseases, the “classic” overweight phenotype is most common. In RA, a “hidden” phenotype was detected less often than in SLE, at the same time, a “healthy” phenotype is not characteristic of SLE. The frequencies of metabolic disorders and hypertension is low with the “normal weight” and “healthy” phenotype, high – with the “classic”, intermediate – with the “hidden” phenotype.","PeriodicalId":21518,"journal":{"name":"Rheumatology Science and Practice","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88720990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.47360/1995-4484-2023-330-338
G. Tarasova, B. Belov, T. Reshetnyak, M. Cherkasova
Infections remain one of the main causes of morbidity and mortality in patients with immuno-inflammatory rheumatic diseases. Objective – to study the efficacy, immunogenicity and safety of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (AРS). Materials and methods. 91 patients were included in the study: 78 with SLE, of which 18 (23 %) – with secondary AРS, 13 – with primary AРS. 85 patients received immunosuppressive therapy, including 30 – genetically engineered biological drugs (bDMARD); 23 – anticoagulants. PPV-23 was administered subcutaneously, patients were observed for a year after vaccination. Results. Local reactions were observed in 49% of patients with SLE and secondary AРS, in 23% of patients with primary AРS. General reactions were noted in isolated cases, were short-term and did not require additional prescriptions. During the follow-up period, no exacerbations of SLE, relapses of thrombosis and thromboembolism associated with vaccination were detected; no development of new autoimmune diseases was registered. 10 (13%) patients with SLE were immunized against the background of high activity of the disease, no adverse reactions were recorded. In some patients, a transient increase in a-DNA and ANF was observed during the year without signs of exacerbation of the disease. 56% of patients with SLE and secondary AРS, 15.4% with primary AРS were “responders” to the vaccine. There was no negative effect on the immune response of the dose of GC >10 mg/day, age, duration and activity of the disease. With the treatment of bDMARD, a full-fledged vaccine response was recorded much less frequently than with standard therapy (38% and 67.4%, respectively; p=0.01). After vaccination, there was a significant decrease in the number of lower respiratory tract infections (LRTI) (p=0.0001), including community-acquired pneumonia (PN) (p=0.03) and acute bronchitis (p=0.04), ENT infections (p=0.001). In the treatment of rituximab (RTM), compared with belimumab (BLM), a greater number of LRTI was observed, mainly due to PN. After vaccination on RTM therapy, the number of INDP in general (p=0.008) and PN in particular (p=0.03) decreased, isolated cases of LRTI and ENT organs were recorded on BLM therapy. Within 4–6 years after vaccination, 30 patients with SLE retained the clinical effect of vaccination, while immunogenicity decreased to 18%. Conclusion. Safety, sufficient immunogenicity, and clinical efficacy of PPV-23 in patients with SLE and AРS have been shown. The use of bDMARD reduces the vaccine response. Immunization performed prior to or during treatment with bDMARD lasting <1 year increases the number of vaccine responders.
{"title":"Vaccination of pneumococcal infection in patients with systemic lupus erythe matosus and antiphospholipid syndrome: experience of 6 years of use","authors":"G. Tarasova, B. Belov, T. Reshetnyak, M. Cherkasova","doi":"10.47360/1995-4484-2023-330-338","DOIUrl":"https://doi.org/10.47360/1995-4484-2023-330-338","url":null,"abstract":"Infections remain one of the main causes of morbidity and mortality in patients with immuno-inflammatory rheumatic diseases. Objective – to study the efficacy, immunogenicity and safety of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (AРS). Materials and methods. 91 patients were included in the study: 78 with SLE, of which 18 (23 %) – with secondary AРS, 13 – with primary AРS. 85 patients received immunosuppressive therapy, including 30 – genetically engineered biological drugs (bDMARD); 23 – anticoagulants. PPV-23 was administered subcutaneously, patients were observed for a year after vaccination. Results. Local reactions were observed in 49% of patients with SLE and secondary AРS, in 23% of patients with primary AРS. General reactions were noted in isolated cases, were short-term and did not require additional prescriptions. During the follow-up period, no exacerbations of SLE, relapses of thrombosis and thromboembolism associated with vaccination were detected; no development of new autoimmune diseases was registered. 10 (13%) patients with SLE were immunized against the background of high activity of the disease, no adverse reactions were recorded. In some patients, a transient increase in a-DNA and ANF was observed during the year without signs of exacerbation of the disease. 56% of patients with SLE and secondary AРS, 15.4% with primary AРS were “responders” to the vaccine. There was no negative effect on the immune response of the dose of GC >10 mg/day, age, duration and activity of the disease. With the treatment of bDMARD, a full-fledged vaccine response was recorded much less frequently than with standard therapy (38% and 67.4%, respectively; p=0.01). After vaccination, there was a significant decrease in the number of lower respiratory tract infections (LRTI) (p=0.0001), including community-acquired pneumonia (PN) (p=0.03) and acute bronchitis (p=0.04), ENT infections (p=0.001). In the treatment of rituximab (RTM), compared with belimumab (BLM), a greater number of LRTI was observed, mainly due to PN. After vaccination on RTM therapy, the number of INDP in general (p=0.008) and PN in particular (p=0.03) decreased, isolated cases of LRTI and ENT organs were recorded on BLM therapy. Within 4–6 years after vaccination, 30 patients with SLE retained the clinical effect of vaccination, while immunogenicity decreased to 18%. Conclusion. Safety, sufficient immunogenicity, and clinical efficacy of PPV-23 in patients with SLE and AРS have been shown. The use of bDMARD reduces the vaccine response. Immunization performed prior to or during treatment with bDMARD lasting <1 year increases the number of vaccine responders.","PeriodicalId":21518,"journal":{"name":"Rheumatology Science and Practice","volume":"25 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89564180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-28DOI: 10.47360/1995-4484-2023-165-180
E. Nasonov, A. Avdeeva, T. Korotaeva, T. Dubinina, J. V. Usacheva
Rheumatoid arthritis (RA) is an immunoinflammatory rheumatic disease (IMRI) characterized by chronic erosive arthritis and systemic damage to internal organs, leading to early disability and reduced life expectancy in patients. Thanks to the progress in the study of the mechanisms of the development of the IVRI and industrial biotechnology, new anti-inflammatory drugs have been created, the use of which has significantly increased the effectiveness of the pharmacotherapy of RA. However, the possibilities of pharmacotherapy for RA are limited, since all genetically engineered biological drugs (GEBDs), regardless of the mechanism of action, have approximately the same effectiveness in achieving remission. It is believed that the relatively unsatisfactory results of RA therapy are due to the heterogeneity of the mechanisms of inflammation. and pain. The significance of the Th17 type of immune response in the pathogenesis of RA, the results of controlled studies of IL-17 inhibitors, and the advisability of further studying the effectiveness of these drugs in patients with certain RA phenotypes are discussed.
{"title":"The role of interleukin 17 in the pathogenesis of rheumatoid arthritis. Are there any prospects for the use of IL-17 inhibitors?","authors":"E. Nasonov, A. Avdeeva, T. Korotaeva, T. Dubinina, J. V. Usacheva","doi":"10.47360/1995-4484-2023-165-180","DOIUrl":"https://doi.org/10.47360/1995-4484-2023-165-180","url":null,"abstract":"Rheumatoid arthritis (RA) is an immunoinflammatory rheumatic disease (IMRI) characterized by chronic erosive arthritis and systemic damage to internal organs, leading to early disability and reduced life expectancy in patients. Thanks to the progress in the study of the mechanisms of the development of the IVRI and industrial biotechnology, new anti-inflammatory drugs have been created, the use of which has significantly increased the effectiveness of the pharmacotherapy of RA. However, the possibilities of pharmacotherapy for RA are limited, since all genetically engineered biological drugs (GEBDs), regardless of the mechanism of action, have approximately the same effectiveness in achieving remission. It is believed that the relatively unsatisfactory results of RA therapy are due to the heterogeneity of the mechanisms of inflammation. and pain. The significance of the Th17 type of immune response in the pathogenesis of RA, the results of controlled studies of IL-17 inhibitors, and the advisability of further studying the effectiveness of these drugs in patients with certain RA phenotypes are discussed.","PeriodicalId":21518,"journal":{"name":"Rheumatology Science and Practice","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82260790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-28DOI: 10.47360/1995-4484-2023-220-235
V. Bialik, M. Makarov, E. Byalik, S. Makarov, A. Karateev, V. Nesterenko, A. A. Chernikova, D. V. Kapitonov, A. I. Gorelova
Avascular necrosis (AN) of bone tissue is a common pathology that affects people of any age, more often young and able-bodied. The disease leads to rapid destruction of the subchondral bone and collapse, followed by the development of secondary osteoarthritis (OA) of the affected joint.The purpose of this review article is to present the accumulated knowledge about the prevalence of AN, the most commonly affected joints, risk factors and pathogenesis of the disease. Since most of the world’s literature sources present knowledge about the individual parts and facts that make up the pathogenesis of AN, this article analyzes all known paths of the development of the disease from the onset of ischemia to collapse and the development of secondary OA and the pathogenesis is presented in chronological order. Based on the results of the article, a definition of the term AN was proposed, and the stages of the disease within the pathogenesis, the most promising for conservative methods of treatment, were identified.
{"title":"Avascular necrosis of bone tissue: Definition, epidemiology, types, risk factors, pathogenesis of the disease. Analytical review of the literature","authors":"V. Bialik, M. Makarov, E. Byalik, S. Makarov, A. Karateev, V. Nesterenko, A. A. Chernikova, D. V. Kapitonov, A. I. Gorelova","doi":"10.47360/1995-4484-2023-220-235","DOIUrl":"https://doi.org/10.47360/1995-4484-2023-220-235","url":null,"abstract":"Avascular necrosis (AN) of bone tissue is a common pathology that affects people of any age, more often young and able-bodied. The disease leads to rapid destruction of the subchondral bone and collapse, followed by the development of secondary osteoarthritis (OA) of the affected joint.The purpose of this review article is to present the accumulated knowledge about the prevalence of AN, the most commonly affected joints, risk factors and pathogenesis of the disease. Since most of the world’s literature sources present knowledge about the individual parts and facts that make up the pathogenesis of AN, this article analyzes all known paths of the development of the disease from the onset of ischemia to collapse and the development of secondary OA and the pathogenesis is presented in chronological order. Based on the results of the article, a definition of the term AN was proposed, and the stages of the disease within the pathogenesis, the most promising for conservative methods of treatment, were identified.","PeriodicalId":21518,"journal":{"name":"Rheumatology Science and Practice","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80282474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-28DOI: 10.47360/1995-4484-2023-158-164
T. Beketova, N. О. Levina, M. V. Dubinskaia, Yu. A. Uskova, I. V. Rozanova, V. Babak, M. Beketova, T. Krasnova
The problem of prevention of coronavirus disease 2019 (COVID-19) in patients with immune-mediated inflammatory rheumatic diseases (IMRD) remains highly relevant. The presence of IRD is associated with a high risk of disease and severe course of COVID-19 during immunosuppressive treatment, primarily anti-B cell therapy with rituximab (RTX), and a low level of post-vaccination response in such patients. A new strategy for the prevention and treatment of COVID-19 are virus-neutralizing monoclonal antibodies to coronavirus; currently, combined long-acting monoclonal antibodies tixagevimab and cilgavimab (Evusheld) are registered for prevention in the world and the Russian Federation. . Tixagevimab and cilgavimab (TC) show neutralizing activity against SARS-CoV-2, including the Omicron strain, primarily its variants BA.4, BA.5, BA.2.75 ("Centaur").Objective – to evaluate the efficacy and safety of TC for pre-exposure prophylaxis of COVID-19 in rheumatic patients receiving RTX, based on a prospective observational study.Materials and methods. The main group included 86 patients with various IMRD receiving RTX: 50 of them had ANCA-associated systemic vasculitis (AAV), 15 – rheumatoid arthritis, 9 – Sjogren’s syndrome (SS), 4 – IgG4-related disease, 3 – systemic lupus erythematosus (SLE), 3 – dermatomyositis (DM), 2 – systemic scleroderma (SSD). Median age was 59 (19–82) years; male : female ratio – 1:1,8. From March 26 to August 30 2022, patients received a single intramuscular injection of TC in a total dose of 300 mg, mainly after RTX (in 52% of cases, in 28% on the next day after RTX). The control group included 42 patients with AAV (median age – 45 (35–71) years; male : female ratio – 1:1), also treated with RTX, who did not receive pre-exposure prophylaxis of TC. The duration of observation was 7 months, until November 1 2022. At this time, 98% of confirmed cases of coronavirus in the Russian Federation were Omicron. A telephone and/or online survey of patient has been conducted to detect cases of COVID-19 and adverse reactions.Results. In the TC group, confirmed coronavirus infection have been detected in 17 (20%) patients (AAV – 10, SS – 3, SSD – 2, SLE – 1, DM – 1), with fever in 7 (8%), only in one case hospitalization was required (lung damage was not detected in computed tomography), in two cases, according to CT mild lung damage (CT 1–2), there were no deaths. Good TC’s tolerability was noted, signs not associated with COVID-19 or progression of IMRD after administration of TC were observed in 8 (9%) patients (GPA – 3 MPA – 1, RA – 2, SLE – 1, IgG4-related disease – 1), adverse reactions definitely associated with the use of TC were not found. The most serious event not associated with coronavirus infection was the progression of polyneuropathy in a patient with RA. In the control group, 3 (7%) patients were diagnosed with COVID-19, one with severe lung injury (CT 3, pulmonary embolism) and death.Conclusions. The data of clinical studies and
{"title":"Experience with Tixagevimab and Cilgavimab (Evusheld) in 86 rheumatic patients undergoing anti-B cell therapy with rituximab","authors":"T. Beketova, N. О. Levina, M. V. Dubinskaia, Yu. A. Uskova, I. V. Rozanova, V. Babak, M. Beketova, T. Krasnova","doi":"10.47360/1995-4484-2023-158-164","DOIUrl":"https://doi.org/10.47360/1995-4484-2023-158-164","url":null,"abstract":"The problem of prevention of coronavirus disease 2019 (COVID-19) in patients with immune-mediated inflammatory rheumatic diseases (IMRD) remains highly relevant. The presence of IRD is associated with a high risk of disease and severe course of COVID-19 during immunosuppressive treatment, primarily anti-B cell therapy with rituximab (RTX), and a low level of post-vaccination response in such patients. A new strategy for the prevention and treatment of COVID-19 are virus-neutralizing monoclonal antibodies to coronavirus; currently, combined long-acting monoclonal antibodies tixagevimab and cilgavimab (Evusheld) are registered for prevention in the world and the Russian Federation. . Tixagevimab and cilgavimab (TC) show neutralizing activity against SARS-CoV-2, including the Omicron strain, primarily its variants BA.4, BA.5, BA.2.75 (\"Centaur\").Objective – to evaluate the efficacy and safety of TC for pre-exposure prophylaxis of COVID-19 in rheumatic patients receiving RTX, based on a prospective observational study.Materials and methods. The main group included 86 patients with various IMRD receiving RTX: 50 of them had ANCA-associated systemic vasculitis (AAV), 15 – rheumatoid arthritis, 9 – Sjogren’s syndrome (SS), 4 – IgG4-related disease, 3 – systemic lupus erythematosus (SLE), 3 – dermatomyositis (DM), 2 – systemic scleroderma (SSD). Median age was 59 (19–82) years; male : female ratio – 1:1,8. From March 26 to August 30 2022, patients received a single intramuscular injection of TC in a total dose of 300 mg, mainly after RTX (in 52% of cases, in 28% on the next day after RTX). The control group included 42 patients with AAV (median age – 45 (35–71) years; male : female ratio – 1:1), also treated with RTX, who did not receive pre-exposure prophylaxis of TC. The duration of observation was 7 months, until November 1 2022. At this time, 98% of confirmed cases of coronavirus in the Russian Federation were Omicron. A telephone and/or online survey of patient has been conducted to detect cases of COVID-19 and adverse reactions.Results. In the TC group, confirmed coronavirus infection have been detected in 17 (20%) patients (AAV – 10, SS – 3, SSD – 2, SLE – 1, DM – 1), with fever in 7 (8%), only in one case hospitalization was required (lung damage was not detected in computed tomography), in two cases, according to CT mild lung damage (CT 1–2), there were no deaths. Good TC’s tolerability was noted, signs not associated with COVID-19 or progression of IMRD after administration of TC were observed in 8 (9%) patients (GPA – 3 MPA – 1, RA – 2, SLE – 1, IgG4-related disease – 1), adverse reactions definitely associated with the use of TC were not found. The most serious event not associated with coronavirus infection was the progression of polyneuropathy in a patient with RA. In the control group, 3 (7%) patients were diagnosed with COVID-19, one with severe lung injury (CT 3, pulmonary embolism) and death.Conclusions. The data of clinical studies and","PeriodicalId":21518,"journal":{"name":"Rheumatology Science and Practice","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90968420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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