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Ineffectiveness of interleukin 6 inhibitors (iIL6), tocilizumab (TCZ) and sarilimumab in ankylosing spondylitis (AS) was shown in randomized clinical trials. However, there is ample evidence that IL6 is actively involved in the pathogenesis of this disease. In addition, the efficacy of iIL6 in patients with secondary AA-amyloidosis was established.Objective: to analyze the results of TCZ administration in AS, complicated by secondary AA-amyloidosis.Patients and methods. The analysis included 6 patients with AS with secondary AA-amyloidosis. All patients were HLA-B27 positive male. The average age of patients was 44±9.2 years, the average age of the disease onset was 16.3±7.9 years, the average duration of AS was 26.0±7.5 years. All 6 patients had pathomorphologic confirmed secondary AA-amyloidosis: all had kidney affection, 5 patients also had gastrointestinal tract affection and 2 had heart affection. As a first biological drug TCZ was prescribed in 2 patients, and 4 patients had previously received one or more inhibitors of tumor necrosis factor α. The average duration of TCZ treatment was 27.6 [3.0; 36.0] months.Results and discussion. During TCZ therapy, the level of CRP (M±σ) significantly decreased: from 81.1±74.5 to 1.2±0.8 mg/L (pConclusion. The presented data show that in certain clinical situations iIL6 can be highly effective in AS.

Renal AA amyloidosis is the most severe type of renal pathology in patients with ankylosing spondylitis (AS). The characteristic symptoms of AA amyloidosis in rheumatic diseases do not often occur for years, making it difficult to diagnose it early and to start adequate therapy.Objective: to identify the clinical features of AS complicated by secondary AA amyloidosis.Patients and methods. The investigation enrolled 9 patients with AS (according to the 1984 modified New York criteria) and histologically confirmed secondary AA amyloidosis (Group 1). A comparison group included 216 AS patients without amyloidosis (Group 2).Results and discussion. In Group 1 patients, the age at the onset of AS was significantly less and the disease duration was 4 times longer than those in Group 2. All the patients with AA amyloidosis had enthesitis and arthritis, including those of the hip joints. The scores of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP), and the acute phase inflammation index CRP were higher in Group 1 than in Group 2.Conclusion. The clinical feature of AS complicated by secondary AA-amyloidosis is the long duration of the disease and the high frequency of juvenile onset, non-axial manifestations (arthritis, coxitis and enteritis), as well as the high activity of systemic inflammation.

The paper discusses prospects for prescribing tumor necrosis factor-α (TNF-α) inhibitor biosimilars, their interchangeability with original drugs for inflammatory joint diseases. It describes clinical cases when original infliximab is replaced with its biosimilar Flammagis for ankylosing spondylitis. The authors emphasize that it is difficult to predict the interchangeability of original TNF-α inhibitors and biosimilars in rheumatology, and this is confirmed by the above clinical cases. They also indicate that the optimal use of biosimilars requires a constant cooperation of rheumatologists, pharmacologists, and regulatory authorities, which is aimed at protecting the rights of a patient in order to ensure safe, effective and high-quality care. It is concluded that it is advisable to conduct further investigations to develop a special pharmacovigilance system in this area.

Psoriatic arthritis (PsA) is a chronic inflammatory disease of the group of spondylitides, which is associated with psoriasis. The decisive role is played by the activation of the interleukin (IL)-23/IL-17 axis in the pathogenesis of PsA [1]. Secukinumab (SEC) is a fully human antibody that binds to human IL-17A and neutralizes the activity of this cytokine. That the patient has concomitant diseases, chronic hepatitis B virus infection and hepatitis C viral (HCV) infection in particular, limits the use of tumor necrosis factor- α inhibitors in the treatment of PsA [2, 3]. The paper describes a clinical case that demonstrates the successful treatment with SEC in a patient with PsA and concomitant HCV infection. In addition to the safety aspects of the use of SEC to treat chronic HCV infection, the issues on optimal dosing of the drug are discussed.

Family and twin studies have shown that ankylosing spondylitis (AS) has a hereditary nature that is based on a strong association with the leukocyte antigen HLA-B27. However, only 1–5% of HLA-B27 carriers develop AS, which indicates that there are other genetic markers involved in the formation of a predisposition to this disease. A number of genome-wide association studies have convincingly confirmed the role of the STAT4 gene. This gene encodes the protein – the signal transducer and activator of transcription (STAT) protein, which is a predisposing factor for the development of many autoimmune diseases. There are not so many studies of the relationship of STAT4 polymorphisms to the predisposition to AS, and there are no these studies regarding the Russian population.Objective: to study whether there is a possible association of STAT4 rs7574865 gene polymorphism with the predisposition to AS and to assess the activity of this disease using BASDAI and ASDAS scores in the Russian patient population.Patients and methods. A cohort of 203 individuals, including 100 patients (79 men and 21 women) with AS, and 103 healthy volunteers (a control group) was surveyed. Age, gender, duration, and specific features of AS onset, ESR, and CRP levels were assessed. BASDAI and ASDAS scores were calculated to evaluate disease activity.Results and discussion. There was a significant relationship between STAT4 polymorphism and C-reactive protein (CRP) levels and BASDAI and ASDAS-CRP scores. The TT genotype carriers had significantly higher mean activity indices compared to the GG (p=0.001) and GT (p=0.005) genotype carriers for CRP, BASDAI (p=0.0001 and p=0.009, respectively) and ASDAS-CRP (p=0.009 and p=0.001, respectively). High disease activity (BASDAI >4 and ASDAS-CRP >3.5) was also associated with the high frequency of the T allele (p=0.046 and p=0.004, respectively). The value of STAT4 rs7574865 gene polymorphism in the pathogenesis of autoimmune diseases is confirmed by a study in which the T allele in STAT4 rs7574865 enhances mRNA transcription and protein expression. Italian authors have shown that there is a relationship between the minor T allele of rs7574865 and the high risk of arthritis. We have previously established a relationship between the T allele and the predisposition to diffuse systemic scleroderma, interstitial lung damage, and elevated anti-topoisomerase I antibody levels.Conclusion. The present study has shown for the first time a significant association of STAT4 rs7574865 polymorphism with the main AS activity indicators: CRP levels, BASDAI and ASDAS-CRP scores. The studied polymorphism may be a new genetic marker for predicting the severity of AS.

Diffuse idiopathic skeletal hyperostosis, or Forestier's disease (FD), is a rare non-inflammatory disease of the locomotor apparatus, which is associated with ligament and tendon ossification that gradually results in ankylosis. In a number of cases, the clinical and radiographic patterns of FD are similar to those of ankylosing spondylitis (AS), which requires a differential diagnosis. The paper describes two clinical cases demonstrating difficulties in the differential diagnosis of FD and AS.

Objective: to evaluate the psychometric properties of the Russian-language version of the routine assessment of patient index data (RAPID-3) questionnaire in patients with rheumatoid arthritis (RA). Subjects and methods. The reliability, sensitivity, and validity of the RAPID-3 index were estimated in 100 patients with verified RA. Reliability assessment comprised the study of the reproducibility and internal consistency of the index. The reproducibility was assessed by the test-retest method; the internal consistency was estimated calculating the Cronbach-alpha coefficient; the sensitivity was determined comparing the RAPID-3 values with a response to treatment according to the ACR-50 criteria. Design validity was ascertained using correlation analysis with external criteria. Results. Test-retest analysis in patients with unchanged health status failed to reveal statistically significant differences between the initial (15.17±5.57) and repeat (13.1±5.89) values of the RAPID-3 index; the Cronbach-alpha coefficient was 0.8. Improved health according to the ACR-50 criteria was correlated with better RAPID-3 values. Lower disease activity in accordance with the RAPID-3 index was more marked in patients who had achieved 50% improvement as shown by the ACR criteria. The posttreatment decline in the RAPID-3 index averaged 3.9±0.1 scores. In patients who had not achieved 50% improvement by the hospital discharge, the disease activity change was less pronounced (Δ RAPID-3 = 1.9±0.2 scores). There were high correlations of RAPID-3 values with clinical parameters: the number of swollen joints (R=0.61) and tender joints (R = 0.46), combined DAS 28 indices (R=0.72), simple (R=0.60) and clinical (R=063) disease activity indices (SDAI and CDAI), inflammation activity index (IAI) (R=0.62), health assessment questionnaire (HAQ) (R=0.64), and quality of life questionnaire (EQ-5D) scores (R=0.52). Conclusion. The RAPID-3 index is a reliable, sensitive, and valid tool to evaluate inflammation activity and functional status in patients with RA