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During the three years that have passed since the beginning of the COVID-19 pandemic, many new fundamental and medical problems have been discovered regarding the relationship between the viral infection and many common chronic non- infectious diseases. Among the latter, an important position is occupied by immuno-inflammatory rheumatic diseases (IIRD), which include rheumatoid arthritis (RA). To date, there is no doubt that patients with RA are at risk for SARS-CoV-2 infection, a severe course of infection that necessitates hospitalization and death. The article presents current data on the course and outcomes of COVID-19 in patients with RA. The literature and own data on postcovid syndrome in this group of patients are presented. The necessity of vaccination against SARS-CoV-2 in patients with IIRD, including those with RA, was substantiated. The prospects for further study of the features of COVID-19 in patients with RA are outlined.

Aim. To compare the features of the course of the disease and the therapy in rheumatoid arthritis (RA) patients who meet the criteria of difficult-to-treat RA (D2T). Materials and methods. The study included 505 RA patients (ACR/EULAR 2010). Rheumatologist experts discussed all patients, since the treatment of RA ware perceived as problematic and/or insufficient. All patients had at least one of the following signs: the activity of the disease is no lower than moderate; the inability to reduce the dose of glucocorticoids to low; rapid radiological progression; RA symptoms causing a decrease in quality of life. The D2T group included 35 patients with true inefficiency or intolerance of two or more of bDMARDs/tsDMARDs of different mechanism of action. The control group (K) included patients with RA who already had experience of taking at least one class of bDMARDs/tsDMARDs (n=291). Results. On average, every 15 patients (7%) with RA met the EULAR criteria for D2T. The median age of patients in the D2T group was 45 years, which is less than in K (Me 54 [43; 62] years; p=0.046). The duration of RA in both groups was comparable. The severity of articular destruction in D2T was higher than in K (stage IV in 40% and 23%, respectively). Positivity for the RF and ACPA in D2T was less common than in K (60% and 85.9%; 60% and 76.6%, respectively). The presence of systemic manifestations of RA was more typical for K than for D2T (28.6% and 63%, p=0.0001). In the group of D2T patients, the number of previously taken DMARDs was higher than in K (p=0.002). Methotrexate was more often prescribed as the first DMARDs in both groups (in 62.9 and 65.7%, respectively). Initiation of bDMARDs/tsDMARDs therapy in D2T was more often performed by TNF-a inhibitors (OR 2.8; p=0.003) and co-stimulation blocker abatacept (OR 4.6; p=0.004), and in control by B-cell inhibitor rituximab (OR 6.9; p0.0001). Conclusion. The results of this study suggest that in Russia, as well as abroad, the principle of RA treatment treat to target has not yet become widespread, and the development of adequate therapy takes too much time.

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disease of unknown etiology that mainly affects the joints, but extra-articular symptoms may also occur. The global prevalence of RA is approximately 5 cases per 1,000 adults[1]. A better understanding of the pathophysiology of the disease in the treatment of RA has led to the development of more effective treatments. Current drugs include glucocorticoids (GCs) and synthetic and biological disease-modifying anti-rheumatic drugs (DMARDs). Apart from these, the most commonly used analgesics are non-steroidal anti-inflammatory drugs (NSAIDs). BLMPs work by targeting specific molecules involved in the inflammatory process, not just symptom relief. Purpose: To review the currently available PubMed data on biologics and exercise for RA and their mechanisms in the context of disease pathophysiology and future prospects. Brief description of the state of knowledge: BLMPs are a necessary alternative in patients who have not achieved the treatment goal for 6 months or have experienced side effects during treatment with conventional disease-modifying drugs. We also analyzed the effect of exercise on the course of RA. Conclusions: The introduction of bDMARDs has opened a new era in the treatment of diseases such as RA. However, due to the difficult access to this form of therapy, side effects, contraindications to currently used drugs, and increasingly well-known mechanisms, there is also a need to constantly search for new solutions. A growing body of evidence in recent years suggests that regular physical activity has a positive effect on various aspects of RA, including disease-related outcomes, mental well-being, and cardiovascular health. Also in this non-pharmacological field, further research is needed to fully understand the mechanisms behind these effects.

Aim. Analysis of survival on biological therapy in previously bionaive patients with rheumatoid arthritis (RA) during the first year of therapy in real clinical practice. Materials and methods. The retrospective study included 204 adult patients with RA. In the hospital, patients were first prescribed therapy with various biological disease-modifying antirheumatic drugs (bDMARDs): infliximab, adalimumab, etanercept, certolizumab pegol, tocilizumab, abatacept (ABA), rituximab (RTM). Patients were divided by age in accordance with the classification adopted by WHO. Clinical forms of RA were presented: RA, seropositive for rheumatoid factor, RA, seronegative for rheumatoid factor, RA with extra-articular manifestations, adult-oneset Stills disease, juvenile RA. The reasons for the cancellation of bDMARD during the first year of treatment were: insufficient effectiveness (including primary inefficiency), adverse events, administrative reasons, clinical and laboratory remission, death. Results. A year after being included in the study, treatment was continued in 92 (45%) patients and was discontinued in 112 patients. The average time of treatment amounted to 0.750.33 years. The longest duration of treatment was in the RTM and ABA groups (0.920.22 and 0.830.29 years, respectively). In 56 (50%) patients, bDMARD was canceled due to insufficient effectiveness (including primary inefficiency), 28 patients (25%) due to the development of adverse reactions, 19 (17%) patients for administrative reasons, 7 (6.25%) patients due to drug remission. During the first year of therapy, there were 2 (1.75%) deaths due to severe comorbid conditions in patients, one of whom received RTM, the other tocilizumab. Conclusion. Study showed that 45% of patients with RA continue treatment with first-time bDMARD for more than 12 months. The most common reason for discontinuation of therapy was its lack of effectiveness. The best survival rate of bDMARDs was observed in RTM and ABA. When selecting bDMARD in each case, it is necessary to take into account the continuity at all stages of treatment.