Стратегия лечения системной красной волчанки «до достижения цели» (Treat-to-Target SLE). Pекомендации международной рабочей группы и комментарии российских экспертов Соловьев С.К., Асеева Е.А., Попкова Т.В., Клюквина Н.Г., Решетняк Т.М., Лисицына Т.А., Кошелева Н.М., Цанян М.Э., Меснянкина А.А., Панафидина Т.А., Кондратьева Л.В., Середавкина Н.В., Герасимова E.В.Начало нового тысячелетия ознаменовано существенным прогрессом в развитии ревматологии: более глубо-ко изучен патогенез многих ревматических заболеваний (РЗ), валидированы критерии диагностики, разра-ботаны индексы активности, внедрены понятия ремиссии и обострения, большое внимание стало уделяться изучению качества жизни пациентов. Существенно расширена возможность фармакотерапии иммуновоспа-лительных РЗ за счет появления генно-инженерных биологических препаратов (ГИБП). Изменилась и стра-тегия терапии пациентов с РЗ. В 2010 г. выдвигается концепция «Лечение до достижения цели» (Treat to Target) для ревматоидного артрита, а позднее для анкилозирующего спондилита. В январе 2013 г. по инициа-тиве ведущих мировых ревматологов стартовал проект создания концепции «Лечение до достижения цели» для системной красной волчанки (СКВ). Результатом их работы стали опубликованные в 2014 г. рекоменда-ции «Лечение СКВ до достижения цели», сформулированные в виде 4 основополагающих принципов и 11 основных рекомендаций. Цель данной публикации -общая характеристика основных положений принципов и рекомендаций с комментариями ведущих специалистов-люпологов с учетом особенностей СКВ в Российской Федерации и обсуждением некоторых дискуссионных и нерешенных проблем. Ключевые слова: системная красная волчанка; «Лечение до достижения цели»; мониторинг. Для ссылки: Соловьев СК, Асеева ЕА, Попкова ТВ и др. Стратегия лечения системной красной волчанки «до достижения цели» (Treat-to-Target SLE). Pекомендации международной рабочей группы и комментарии рос-сийских экспертов. Научно-практическая ревматология. 2015;53(1):9-16. The start of the new millennium is marked by a substantial progress in the development of rheumatology: pathogenesis of many rheumatic diseases (RDs) was more deeply studied; their diagnostic criteria validated; disease activity indices worked out; the concepts of remission and exacerbation introduced; much attention has been given to the investigations of quality of life in patients. The possibility of pharmacotherapy for immunoinflammatory RDs was extended by the advent of biological agents (BA). The treatment strategy for RDs was also changed. The treat-to-target concept was put forth for rheumatoid arthritis in 2010 and for ankylosing spondylitis later. The project of treat-to-target concept in systemic lupus erythematous (SLE) was launched on the initiative of the world's leading rheumatologists in January 2013. The result of their work is the treat-to-target-in-SLE recommendations published in 2014 and formulated as 4 basic principles and 11 general recommendations. The purpose of this publication is to provide general characteristics of the basic provisions...

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The antiphospholipid syndrome (APS) is an acquired thrombophilic disorder in which autoantibodies are produced to a variety of phospholipids determinants of cell membranes or phospholipid binding proteins. There are few reports about association between antiphospholipid antibodies and development of Budd-Chiari syndrome (BCS). We report the case of BCS development in young Russian male with primary APS. The patient underwent orthotopic liver transplantation on August 26, 2012. At present time his state is good, the blood flow in the liver restored and its function is not impaired. We report about the first time the successful use of dabigatran etexilate for prolonged anticoagulation therapy in APS patient with BCS. In addition patient is managed with immunosuppressive drugs.

Background. The nature and rate of gastric mucosal (GM) damage in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) remain to be among the unsolved problems. Objective. To define the role of H. pylori and drugs in the development of GM damages in SLE and APS. Methods. A study was conducted on 85 patients with SLE and APS. All the patients underwent esophagogastroduodenoscopy with targeted biopsy of the mucosa of the gastric body and antrum. The presence of H. pylori in the gastric biopsy specimens was determined using polymerase chain reaction. Results. Endoscopic examination revealed that the patients with SLE and APS on admission had the following GM changes: antral gastritis (82.4%), erosions (24.7%), hemorrhages (8.2%), and pangastritis (8.2%). SLE and APS patients showed no direct correlation between the found GM damages and the presence of H. pylori. The use of glucocorticoid, low-dose acetylsalicylic acid, nonsteroidal anti-inflammatory drug, and anticoagulant in SLE and APS patients is accompanied by GM damage. Conclusion. There was no evidence of the role of H. pylori in GM damage in the SLE and APS patients. More frequent detection of H. pylori was observed in anticoagulants or low-dose acetylsalicylic acid users than in glucocorticoids and nonsteroidal anti-inflammatory drugs ones.

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О р и г и н а л ь н ы е и с с л е д о в а н и я

Objective: to determine risk factors (RFs) for venous thromboembolic events (VTE) in patients with rheumatoid arthritis (RA).Subjects and methods: The investigation enrolled 374 patients (311 women and 63 men) with a reliable diagnosis of RA who met the 2010 ACR/EULAR classification criteria. The patients' mean age was 53.7±13.6 years; the disease duration was 12.1±10.7 years. All the patients were treated at the V.A. Nasonova Research Institute of Rheumatology Clinic during the period from 2014 to 2017. A standard clinical examination of the peripheral joints was performed. RA activity was measured using DAS28. A survey was made using a questionnaire including questions on traditional RFs for VTE and RFs that might be caused by RA and its therapy. Results and discussion. VTE were recorded in 45 (12%) out of the 374 patients. Group 1 included 45 patients with VTE; Group 2 consisted of 329 patients without VTE. Multidimensional analysis showed an increased risk of developing VTE in RA under the influence of the following factors: high inflammatory activity; lower extremity varicose veins; hypercholesterolemia; and hypertension. Their weighted coefficients were 1.1, 2.5, 1.0, and 0.9, respectively. According to the obtained model (p<0.001), the risk of VTE in RA can be predicted by the following formula: Z = 1.1 • high RA activity (Yes = 1/No = 0) + 2.5 • lower extremity varicose veins (Yes = 1/No = 0) + 1.0 • hypercholesterolemia (Yes = 1/No = 0) + 0.9 • hypertension (Yes = 1 / No = 0).Conclusion: The increased risk for VTE in RA patients determines the need for its timely assessment, by taking into account the known risk factors as both standard ones and those caused by the disease itself and its therapy. This risk assessment is necessary for the timely adequate treatment and prevention of thrombotic events in RA.

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