In early RA, in the synovial membrane, the rate of apoptosis and p-53-immunostaining intensity were low, and Bcl-2-immunostaining intensity was high. The sFas level in synovial fluid was high. In late RA, the rate of apoptosis and p-53-immunostaining intensity increased, Bcl-2-immunostaining intensity decreased, as did the sFas level.

The paper gives the recommendations for the assessment of disease activity and functional status in patients with ankylosing spondylitis in clinical practice, which have been developed by experts, by taking into account international and Russian experience in managing these patients.

В статье представлены рекомендации по лекарственной терапии аксиальных спондилоартритов, разработан-ные Экспертной группой по изучению спондилоартритов (ЭкСпА). Рекомендации описывают тактику веде-ния пациентов в наиболее частых клинических ситуациях, направленную на обеспечение максимальной эф-фективности и безопасности лечения. Ключевые слова: спондилоартриты; аксиальные спондилоартриты; анкилозирующий спондилит; болезнь Бехтерева; нестероидные противовоспалительные препараты; ингибиторы фактора некроза опухоли α; ин-гибиторы интерлейкина 17; безопасность терапии. Для ссылки: Гайдукова ИЗ, Ребров АП, Лапшина СА и др. Применение нестероидных противовоспали-тельных препаратов и генно-инженерных биологических препаратов для лечения аксиальных спондилоар-тритов. Рекомендации Экспертной группы по изучению спондилоартритов при Общероссийской общест-венной организации «Ассоциация ревматологов России». Научно-практическая ревматология. 2017;55(5):474-484. The paper gives recommendations for the drug therapy of axial spondyloarthritides, which have been developed by the Spondyloarthritis Study Group of Experts. The recommendations describe the patient management tactic in the most common clinical situations, which is aimed at maximizing the efficacy and safety of treatment. Key words: spondyloarthritides; axial spondyloarthritides; ankylosing spondylitis; Bechterew's disease; nonsteroidal anti-inflammatory drugs; tumor necrosis factor-α inhibitors; interleukin-17 inhibitors; safety of therapy. For reference: Gaidukova IZ, Rebrov AP, Lapshina SA, et al. Use of nonsteroidal anti-inflammatory drugs and biological agents for the treatment of axial spondyloarthritides. USE OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS AND BIOLOGICAL AGENTS FOR THE TREATMENT OF AXIAL SPONDYLOARTHRITIDES. RECOMMENDATIONS OF THE SPONDYLOARTHRITIS STUDY GROUP OF EXPERTS, ALL-RUSSIAN PUBLIC ORGANIZATION «THE ASSOCIATION OF RHEUMATOLOGY

Apoptosis markers (p53, PUMA, p21, and Mdm2) were studied in patients with rheumatoid arthritis at the early and late stages of disease on bone marrow smears and frozen sections of the articular synovial membrane. The target molecules were found in all patients. The early stage was characterized by maximum expression of antiapoptotic (Mdm2) molecule and the minimum expression of proapoptotic molecules (p53, PUMA, and p21). The proapoptotic proteins predominated in patients with the late stage of rheumatoid arthritis, while the antiapoptotic factor (Mdm2) was depressed significantly. These data suggested total suppression of apoptosis at the early stage of rheumatoid arthritis and recommended the Mdm2 molecule as a prospective target for the development of new drugs.

The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm for the management of knee osteoarthritis (OA), published in December 2014, provides practical guidance for the prioritization of interventions. This current paper represents an assessment and endorsement of the algorithm by Russian experts in OA for use in Russian clinical practice, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA, in support of the clinicians’ individualized assessment of the patient. Medications recommended by the ESCEO algorithm are available in Russia. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOA) is advised, for which high-quality evidence is provided only for the formulations of patented crystalline glucosamine sulphate (pCGS) (Rottapharm/Meda) and prescription chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs) may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs but without the systemic safety concerns. To be effective, topical NSAIDs must have high bioavailability, and among NSAIDs molecules like etofenamate have high absorption and bioavailability alongside evidence for accumulation in synovial tissues. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk: benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of weekly injections. As a last step before surgery, the slow titration of sustained-release tramadol, a weak opioid, affords sustained analgesia with improved tolerability.

No abstract

BackgroundCurrently a number of risk factors (RF) are considered to be responsible for radiological progression of knee osteoarthritis (OA), nevertheless key predictors of OA progression have not yet been established.ObjectivesTo identify RF predicting radiological progression of knee joint osteoarthritis (OA) in a 5 year multicenter prospective study.MethodsThis study of RF predicting knee OA progression was the first with multicenter prospective design ever conducted in Russia. The study included 344 female patients 40–75 y.o with primary stage I-III knee OA (ACR criteria) from 6 centres. Radiological stage was identified by Kellgren J.- Lawrence J. grading scale. The follow up (FUP) was 5 years. Individual patients’ files described 90 parameters. Instrumental diagnostic methods included plain radiography of knee joints, dual energy X-ray absorptiometry (DEXA) of lumbar spine L1–4, femoral neck and subchondral tibia, ultrasound (US) and MRI examination of knee joints. OA progression was verified based on evolution of radiological stage. At baseline 24 pts (7%) had stage I OA, 227 (66%) – stage II, and 93 (27%) – stage III. Discriminant analysis was applied to verify most reliable RF predicting radiological progression.ResultsRadiological progression was documented in 45% participants during 5 year FUP. The groups with and without progression were comparable in terms of age and disease duration (»<0,05). Pts who progressed suffered more intensive knee pain – 68(52–72) vs 41(30–63) mm, » <0,01, had higher body weight – 82(77–93) vs 72(65–81) kg, » <0,01, had higher rates of knee synovitis (US) 44% vs 26%, »=0,03, (RR=1,67, 95% CI 1,07–2,59) and mid-tibia bone marrow oedema – 60% vs 28%, » <0,01 (RR=2,12, 95% CI 1,34–3,35). The discriminant analysis showed that knee pain, excessive body weight, synovitis and mid-tibia bone marrow oedema (MRI) can be considered as predictors of OA radiological progression. A model capable of predicting OA course in an individual patient with high 88% accuracy, 87.7% sensitivity and 70% specificity has been developed based on identified RF and their coefficients. Area under the ROC-curve 0, 921 (95% CI 0,875–0,966).ConclusionsKnee pain, excessive body weight, synovitis and bone marrow oedema should be considered as key RF predicting knee OA radiological progression.Disclosure of InterestNone declared

Apoptosis in the cartilage and synovial membrane of the knee joint in patients with rheumatoid arthritis was studied using the immunocytochemical TUNEL method. The degree of apoptosis correlated with the duration of inflammation. The process predominated in the chondroblast population, lymphocytic infiltration, and synovial membrane fibroblasts.