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Aim to identify outdated terms and make changes to the terminology of spondyloarthritis. Materials and methods. At the first stage of the work, the terms divided into two categories: “outdated” definitions and terms that need to be improved or unified. Subsequently, each member of the Expert Group of Spondyloarthritis at the Association of Rheumatologists of Russia (ExSpA) presented by its own definition of the designated term or agreed with the previous term. At the next stage, the existing definitions were put together. After discussion, experts left a term that scored at least 2/3 of the votes. The special opinion of experts was recorded, whose did not coincide with the majority opinion. An open vote was conducted, when defining an “outdated” term with the unanimous decision of all group members, this term was not recommended for further clinical use. Results. The work carried out allowed us to identify a number of terms that are not recommended for use in clinical practice. Number of terms are defined, which should be used when discussing the problem of spondyloarthritis. Conclusion. The Expert Group of Spondyloarthritis at the Association of Rheumatologists of Russia suggests using or, accordingly, not using a number of terms and their definitions in clinical practice.

The article focuses on the problem of secondary ineffectiveness of tumor necrosis factor α infliximab (INF) and describes an attempt of using plasmapheresis (PF) to eliminate this problem in a patient with ankylosing spondylitis who had received INF treatment at a dose of 5 mg/kg for a long time (over 4 years). After PF, the IFF therapy ensured a long-term clinical and laboratory improvement of patient's condition. One can assume that PF made it possible to overcome secondary ineffectiveness of INF and can be used in some patients in cases when INF cannot be replaced with another TNFα inhibitor.

Osteoporosis (OP) is a frequent complication of ankylosing spondylitis (AS). The risk factors of OP in AS are permanent inflammatory activity, disease duration, patient immobilization, and vitamin D deficiency. Proinflammatory cytokines that favor osteoclustogenesis play a fundamental role in the pathogenesis of bone resorption in AS. The problem of OP in AS cannot be viewed in isolation from bone metabolism as a whole and from the processes of pathological osteogenesis. Ankylosis-induced spine rigidity concurrent with vertebral body OP increases the risk of spinal fractures in patients with AS. Osteogenesis in AS leads to overestimation of the results obtained by dual-energy X-ray absorptiometry (DXA) when determining lumbar bone mineral density (BMD). Lateral DXA scanning of the spine is a more sensitive technique for BMD estimation. The early use of tumor necrosis factor-α inhibitors is able to prevent OP in patients with AS.

Objective. To evaluated effect of adalimumab treatment on activity of arthritis, enthesitis, psoriasis and functional status in PsA patients (pts). Subjects and methods. 18 pts with active PsA (12 female, 6 male), median age 43,1±10,2 years (yrs) (range 24-56), median duration of psoriasis 16,7±9,6 yrs (range 4-33), median duration of PsA 9,2±6,7 yrs (range 1,5-23) received Adalimumab 40 mg subcutaneously every other week (wk) for 12 wks in open-label study. Evaluations of treatment effects were conducted by the PSARC, ACR 20, 50 and 70, LEI, PASI, BSA, HAQ and CRP at wks 4 and 12. Results. The sings of activity of PsA at baseline were: DAS=4,8 (4,0; 5,45), LEI=4,25 (0,25; 8,05), PASI=10,5 (7,2; 12,1), BSA=1,75 (1; 2), HAQ=1,125 (0,875; 1,5), СRР=27,9 (11,4; 34,6). After 4 wks all parameters significantly improved: DAS=2,85 (2,1; 3,1), LEI=1,86 (0; 3,97), PASI=6,4 (2,8; 8), BSA=0,75 (0,15; 1), HAQ=0,375 (0,125; 0,625), СRP=1,7 (1,4; 3,2) and were maintained after 12 wks: DAS=1,6 (1,3; 2,03), LEI=0,38 (0; 0,89), PASI=1,1 (0,4; 2,2), BSA=0 (0; 0,9), HAQ=0,312 (0; 0,625), СRР=1,75 (0,7; 3,6); p

Heavy economic expenses for treatment with genetic engineering biologicals (GEB) in patients with rheumatoid arthritis (RA) determine what strategies are most optimal in terms of both their clinical efficiency and economic constituent should be sought for. Objective: To define the most optimal strategies to use tocilizumab and TNF-α inhibitors in a Russian population of patients with different duration of RA. Material and methods. The investigation was based on the cost-benefit analysis using imitation simulation. Modeling relied on the relationship of RA mortality to a patient's functional status rated by the health assessment questionnaire (HAQ). A model was constructed, which simulated the progression of functional incompetence in RA patients seeking medical advice in health care facilities of Russia. Five variants of the model were developed to simulate the sequence of changing the basic anti-inflammatory drugs (BAIDs), including the incorporation of tocilizumab or a TNF-α inhibitor. The first strategy that ignored the use of BAIDs involved palliative therapy alone, by simulating a gradual disease progression, and that was used to obtain data for comparison of results (reference). The second strategy estimated the sequence of BAID changes in the following order: methotrexate (MT) → leflunomide (LF) → sulfasalazine (SS) → azathioprine → palliative therapy. This strategy was also considered to obtain data for comparison of results. The third strategy comprised the use of tocilizumab or a TNF-α inhibitor after determining the resistance or intolerance of MT therapy. The fourth strategy assumed the use of tocilizumab or a TNF-α inhibitor after determining the resistance or intolerance of MT and LF therapy. The fifth strategy envisaged the use of tocilizumab or a TNF-α inhibitor after determining the resistance or intolerance of MT, LF, and SS therapy. The possibility that a combination of BAIDs and MT might be used and the impact of RA duration on lower HAQ scores were taken into account. Direct and indirect costs were calculated in terms of social aspects, their relationship to HAQ scores being derived. The cost of TNF-α inhibitors was taken as that of adalimumab. The model simulated the participation of 10,000 patients in each sequences. The prediction horizon was 10 years. The age of patients and the initial distribution of HAQ scores were taken from the results of the RAISER epidemiological survey. Results. The least additional cost per quality-adjusted life year (QALY) was when GEB was used after 3 synthetic BAIDs, no significant difference being found in the cost of tocilizumab and that of a TNF-αinhibitor. The additional cost for a TNF-α inhibitor used after 3 BAIDs in relatively early RA was about 500,000 rubles; that for tocilizumab was slightly higher - 560,000 rubles. The cost increased with the duration of RA and when the moment of using GEB approached that of discontinuation of the first synthetic BAID - MT. The administration of tocilizumab after MT turned out to be cost-effective in patients with relatively late RA - the cost per QALY was 845,000. The use of synthetic BAIDS was in terms of cost-based effectiveness was most optimal - about 40,000 rubles per QALY. The availability of additional agents permits the choice of the most optimal strategy for the use of GEB. Conclusion. The application of the imitation simulation technique demonstrated that the strategy of using GEB after several synthetic BAIDs in patients with the least duration of the disease is most optimal in the context of cost-based efficiency. In this regard, no great difference was found in the use of tocilizumab or TNF-α inhibitors