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Objective: to identify irreversible organ damages and factors influencing their development and to compare existing musculoskeletal injuries with the activity of systemic lupus erythematosus (SLE).Patients and methods. The investigation enrolled 197 peri- and postmenopausal female outpatients (mean age, 50.94±9.1 years) with SLE, who were followed up at Clinical Rheumatology Hospital Twenty-Five, Saint Petersburg. The mean disease duration was 9.7±7.5 years. Cytostatic and glucocorticoid (GC) treatment regimens and dosages in the examinees were analyzed on the basis of their primary medical records. The investigators assessed the current disease activity by the SLE Disease Activity Index (SLEDAI-2K) and the Lupus Low Disease Activity State (LLDAS) and irreversible organ damages by the Systemic Lupus International Collaborating Clinics (SLICC) Damage Index (DI).Results and discussion. 93.4% of the patients continued to receive GS therapy at the time of inclusion in the study. The median GS maintenance dose was 12.5 mg/day. Almost half of the patients (n=86/43.7%) were in menopause (its mean duration was 12.8±7.1 years). Half of the examinees were noted to have remission (n=36/18.3%) or low SLE activity (n=92/46.7%) according to the SLEDAI-2K. Fifty-seven (28.9%) patients met all 5 LLDAS criteria; at the same time other 96 (48.7%) patients met 4 out of the 5 criteria, the 5th criterion being a high GC maintenance dose. High DI scores of ≥4 were found in two thirds (n=131/66.5%) of the examinees. Musculoskeletal system injuries ranked first among other disorders: osteoporosis (OP) and muscle weakness were detected in 76 (38.6%) and 69 (35.0%) patients, respectively. Regression analysis involving all statistically significant factors showed that the degree of damage was influenced by age (p=0.013215), total GS dose (p=0.000047), and previous therapy with cyclophosphamide (p=0.041505).Conclusion. The contribution of GS therapy to irreversible damage accrual is obvious in peri- and postmenopausal women with SLE. Timely dose adjustment or complete withdrawal of GS during remission in SLE is one of the key factors that substantially reduce the risk of progression of irreversible organ damages due to the prevention of OP and osteoporotic fractures in these patients.

The main goal of treatment for rheumatoid arthritis (RA) is to suppress inflammation using basic and symptomatic therapies. At the same time, the above strategy does not significantly stop joint destruction that leads to disability in patients. The review analyzes publications dealing with a search for intercellular interaction regulators among the main effector cells in the pannus – fibroblast- like synoviocytes (FLSs). It assesses the influence of FLS aggression factors on invasive pannus behavior, the possibility of their targeted deactivation during biological therapy, and the preliminary results of similar treatment by the examples of animal models. It is shown that the most promising targets for biological therapy may be FLS adhesion molecules, such as transmembrane receptor cadherin 11, integrins α5/β1, and VCAM1, ICAM1, which actively participate in the attachment of FLSs to the cartilage surface and activate their production of cytokines, growth factors and aggression factors.

Objective: to estimate the cost of treatment in patients with complicated osteoporosis (OP) in the first year after fracture under the conditions of the Moscow municipal healthcare system.Patients and methods. The investigation enrolled 196 women (mean age, 65.8±9.1 years) who had sustained fractures at five major osteoporotic sites (proximal hip (PH), distal forearm (DF), surgical humeral neck, vertebral column, and medial and/or lateral ankle). A unified questionnaire that included data on inpatient and outpatient treatment, patients' personal costs, and social benefits, as well as tariffs on services of the Moscow City Fund of Obligatory Health Insurance was used to estimate the cost of treatment for complicated OP during one year after fracture.Results. The direct cost of treatment for PH fracture amounted to 101,243 rubles and was significantly higher (p < 0.01) than that for fractures at other sites: DF (22,080 rubles); humeral neck (39,855 rubles), vertebral column (51,167 rubles), and ankle (43,345 rubles). The average cost of treatment in terms of indirect costs of treatment for complicated OP during a year was as high as 61,151 rubles. In the overall cost structure for the disease, hospital costs accounted for 44%; social benefits were 12% and the cost of antiosteoporotic drugs was only 7%, which was associated with the fact that the latter were rarely prescribed by primary healthcare physicians.Conclusion. Costs of treatment in patients with complicated OP in Moscow were estimated in relation to the site of low-energy fracture. The disease was shown to cause considerable economic losses regardless of the site of osteoporotic fracture; however, the cost of antiosteoporotic drugs has an insignificant share in the overall cost structure for treatment. At the same time, secondary prevention of OP requires that combination antiosteoporotic therapy should be performed in all patients who have sustained low-energy fracture.