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Ankylosing spondylitis is a chronic, gradually progressive inflammatory disease characterized by lesions of the sacroiliac joints and / or spine, which can occur with simultaneous lesions of the enthesis and peripheral joints, leading to early disability and a decrease in the quality of life of patients, mainly young age. The international society for evaluation of spondylarthritis (ASAS) recommended a combination of nonpharmacological and pharmacological methods in the treatment and rehabilitation of patients with ankylosing spondylitis for the longest possible preservation of the quality of life of patients, which requires a multidisciplinary therapeutic approach.Currently, in many European countries, the international classification of functioning, disability and health (IСF) is used as a universal approach to the assessment of human health. The IСF classifies the different areas of each patient’s life that are health-related and affect health, thus describing changes in their physical functioning and psychological well-being. It helps to introduce multidisciplinary, patient-centered, problem-oriented rehabilitation care into the real work of clinics.The IСF shows a broader and more meaningful picture of the patient’s health, which allows the multidisciplinary team to consider the patient from different perspectives — biological, personal and social. Using the IСF in the process of complex therapy and rehabilitation of patients with ankylosing spondylitis, a multidisciplinary team can achieve a more complete coherence of views in the treatment of patients with ankylosing spondylitis, which is very important in achieving the success of therapy of this category of patients.

Progress and significant changes in the approaches to the diagnosis and treatment of arthritis determine the need for a comprehensive study of comorbidities in rheumatologic patients. Aim. The evaluation the occurrence of comorbidities in patients with inflammatory diseases of the spine and joints and the assessment of the general changes in comorbidities at the beginning of the XXI century compared to previous period. Materials and methods. Comorbidity was analyzed in 245 patients with spondyloarthritis who participated in the scientific program PROGRESS. Validated comorbidity assessment indices were used in the study. The analysis of 96 sources of literary bases RISC and PubMed were used in literature analysis. The results of their own observation and literary search were compared. Results and discussion. According to the patients’ cards, an analysis of the structure of comorbidities was conducted in 221 patients: 207 (93.66%) patients with spondyloarthritis had two or more comorbidities. The most common diseases were diseases of gastrointestinal tract (60.6%) and cardiovascular pathology (58.3%), secondary osteoarthritis (60.2%). According to literature sources, most of the comorbidities and spondyloarthritis are interrelated pathogenetically and undergo a change in the profile of rheumatic and/or related diseases undergo simultaneous changes. The emergence of new diseases in the structure of comorbidity and new drugs requires the development of recommendations that take into account the presence of comorbidity in patients with a rheumatic diseases. Conclusion. Most patients with spondyloarthritis has comorbidity. The change in rheumatic and non-rheumatic diseases that occurs in the 21st century has a mutual influence, changing the profile of patients and determining the change in the tactics of their management.

To compare the clinical manifestations of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nrAxSpA).A Moscow early spondyloarthritis cohort has now included 132 patients with axial spondyloarthritis, of whom 69 patients who have been followed up at least 12 months are to be involved in a preliminary analysis. The mean age at the time of inclusion in the study was 28.1±5.5 years; the mean disease duration was 24.7±15.8 months; 63 (91.3%) patients were HLA-B27 positive; 41 and 28 included patients were diagnosed with AS and nrAxSpA, respectively.Men were significantly more in the AS group than in the nrAxSpA group (58.5 and 32.1%, respectively; p=0.05). The patients of the two groups did not differ in main clinical parameters (the presence of arthritis and enthesitis), disease activity (BASDAI, ASDAS-CRP) and functional status (BASFI). All indicators of inflammatory activity decreased nearly 2-fold in both groups after 12 months of follow up. In 7 (25%) patients with nrAxSpA, radiologically detectable sacroiliitis (SI) developed over 12 months and the diagnosis of AS was verified. Among them, 2 (28.5%) patients had initially active SI detected by magnetic resonance imaging (MRI); 4 (57.1%) had chronic SI, and 1 (14.4%) had no pathological MRI changes.Due to the fact that the clinical manifestations of AS and nrAxSpA are comparable, it can be assumed that the latter is an early stage of AS.Цель исследования. Сопоставление клинических проявлений анкилозирующего спондилита (АС) и нерентгенологического аксиального спондилоартрита (нр-аксСпА). Материалы и методы. В московскую когорту КоРСар (Когорта Раннего Спондилоартрита) в настоящее время включены 132 больных аксиальным спондилоартритом (аксСпА), из которых в предварительный анализ вошли 69 больных, наблюдавшихся не менее 12 мес. Средний возраст на момент включения в исследование составил 28,1±5,5 года, средняя продолжительность заболевания - 24,7±15,8 мес, 63 (91,3%) больных позитивны по HLA-B27, 41 пациент включен с диагнозом АС, 28 - с нр-аксСпА. Результаты. В группе АС мужчин было достоверно больше, чем в группе с нр-аксСпА (58,5 и 32,1% соответственно; р=0,05). По основным клиническим параметрам (наличию артритов и энтезитов), активности болезни (согласно индексам BASDAI, ASDAS СРБ) и функциональному статусу (индекс BASFI) пациенты двух групп не различались. Через 12 мес наблюдения все показатели воспалительной активности уменьшились почти в 2 раза в обеих группах. У 7 (25%) пациентов с нр-аксСпА за 12 мес развился рентгенологически выявляемый сакроилиит и подтвержден диагноз АС. Изначально среди них у 2 (28,5%) человек имелись выявляемые при магнитно-резонансной томографии (МРТ) признаки активного СИ, у 4 (57,1%) - хронического СИ, а у 1 (14,4%) не выявлено патологических изменений по данным МРТ. Заключение. В связи с сопоставимостью клинических проявлений АС и нр-аксСпА можно предположить, что последний является ранней стадией АС.

В статье по результатам международного опыта и собственных исследований представлены современные направления в лечении аутоиммунных ревматических заболеваний с использованием генно-инженерных биологических антицитокиновых препаратов, ингибиторов внутриклеточных ферментов – киназ для лечения по принципу «treat to target». Данные этой статьи будут полезны или интересны для интернов, резидентов и врачей – ревматологов, а также для преподавателей медицинских университетов., Based on the results of international experience and personal research, the article represents modern methods of treatment of autoimmune rheumatic diseases using genetically-engineered anti-cytokine drugs, inhibitors of intracellular enzyme-kinase for treatment on “treat to target” principle. The article findings will be helpful for interns, residents and rheumatologist physicians, as well as teacher of medical universities., Мақалада халықаралық тәжірибеге және өз зерттеулеріне негізделген аутоиммунды ревматикалық ауруларды заманауи бағытта емдеудің генетикалық инженерлі биологиялық антицитокиндік препараттарды қолдануы, «мақсатты емдеу» принцип бойынша емдеуге арналған жасушааралық ферменттердің ингибиторлары - киназалар көрсетілген. Осы мақаланың деректері интерндерге, резиденттерге және ревматологтарға, сондай-ақ медициналық жоғары оқу орындарының оқытушыларына пайдалы немесе қызықты болады., Наука и здравоохранение, Выпуск 1 (21) 2019

Back pain is a generalized type of locomotor lesion that is caused by soft tissue pathology and degenerative changes in the vertebral column in most cases and by intervertebral disk herniation, spinal stenosis, compression fractures in osteoporosis, by injuries, congenital anomalies, vertebral displacement less frequently, as well as by infections, tumors, inflammatory processes in the vertebral column, and related pain. A number of rheumatic diseases, including seronegative spondylarthritis, Scheuermann-Mau' disease, Forestier's disease, osteoarthrosis, etc., are accompanied by back pain. The cause of back pain syndrome cannot be frequently identified. This abnormality is treated by nonsteroidal antiinflammatory drugs, among which aceclofenac (Aertal) has acquired a reputation as an agent having a good tolerability.