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Влияние лираглутида на микроциркуляцию у крыс с экспериментальным сахарным диабетом, сопровождающимся абсолютной недостаточностью инсулина Федеральное государственное бюджетное образовательное учреждение высшего образования «Саратовский государственный медицинский университет имени В. И. Разумовского»

Objective: to study the clinical characteristics of PsA and working capacity in patients included in the All-Russian PsA Registry.Patients and methods. The investigation enrolled 614 patients aged 19–84 years with psoriasis from 39 subjects the Russian Federation, who were followed up in the All-Russian PsA Registry. On the basis of the assessment of demographic data, the spectrum of comorbidities, the degree of activity of the underlying disease according to Disease Activity Index for PsA (DAPSA) and Disease Activity in 28 joints (DAS28), clinical, functional, and social indicators were analyzed in the patients. The investigators studied information on the patients employment, working capacity, and disability, by assessing the group of the latter. The health status and the presence and severity of functional impairment in the patients were analyzed using the Health Assessment Questionnaire (HAQ), while their working efficiency was estimated according to the Workers Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI-SHP questionnaire), by calculating the following parameters: absenteeism, presenteeism, an overall decrease in labor productivity, and impairment in daily functional activity.Results and discussion. The analysis of the All-Russian PsA Registry showed that most of them were of working age (30 to 59 years); 48.4% had concomitant diseases. Data on DAPSA changes were obtained in 349 patients, who were recorded to have mainly moderate (34.7%) or high (42.7%) disease activity, multiple dactylitides and enthesitides, and limited joint function. The registry reflects information on the social status of 521 patients: employed (61.2%) and unemployed (22.1%) persons, pensioners (15.2%), and students (1.5%). More than one third (37.1%) of patients with PsA had disability, mainly of Group III. The changes in the HAQ disability index were assessed in 326 patients; mild, moderate, and severe functional impairments were observed in 36, 26.4, and 3.7%, respectively. Absenteeism was detected in less than one third of patients with PsA, presenteeism was found in about half; there was an overall decrease in labor productivity in more than 60% and daily activity impairment in 68.8%. Statistically significant direct moderate correlations were established between the indicators of PsA activity (DAPSA and DAS28) and the level of productivity impairment in the patients; this was mostly related to an overall decline in labor productivity and to a decrease in daily activity.Conclusion. The data obtained from real clinical practice suggest that half of the PsA patients had high disease activity and a third had severe functional impairment, which led to a lower quality of life and to disability. The overall decrease in labor productivity and daily activity, which was detected in more than half of the patients, was associated with high PsA activity. The follow-up in the All-Russian PsA Registry, regular anti-inflammatory therapy with disease-modifying antirheumatic drugs and biological agents can improve the clinical and functional status and, consequently, working capacity in patients with PsA.

Objective of the study – to compare, in real clinical practice, according to the data of the Russian Psoriatic Arthritis Registry, characteristics of two groups of psoriatic arthritis (PsA) patients: with and without nail psoriasis.Material and methods. 588 PsA patients (277 males and 311 females) with PsA according to CASPAR criteria were included in the Russian Psoriatic Arthritis Registry. Patients’ age was 48.6±0.5 years, disease duration – 7.0±0.3 years. Patients underwent standard clinical examination of PsA activity. Disease activity measures evaluated in this study included DAPSA (Disease Activity in Psoriatic Arthritis), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDAS-СRP (Ankylosing Spondylitis Disease Activity Score). Enthesitis was measured using LEI (Leeds Enthesitis Index) index. Dactylitis was detected, the number of digits with acute dactylitis was defined. Skin lesion severity was evaluated in terms of BSA (Body Surface Area) affected, and PASI (Psoriasis Area Severity Index); PASI was calculated in case BSA > 3%. The criteria of minimal disease activity (MDA) had been used to assess the treatment efficiency. MDA was achieved if a patient met ≥5 of the 7 following categories: tender joint count (TJC) ≤1, swollen joint count (SJC) ≤1, PASI≤1 or BSA≤3%, patient pain VAS ≤15, patient global activity (PGA) VAS ≤20, Health Assessment Questionnaire Disability Index (HAQ) ≤0.5, and tender entheseal points ≤1. Patients were split into two groups: those with nail psoriasis (group 1), and those without nail psoriasis (group 2).Results. 312 (53.1%) patients had nail psoriasis and 276 (46.9%) did not. Patients’ age in group 1 was 45.7±11.9 years, in group 2 – 48.8±13.2 years (р>0.05). PsA duration in groups 1 and 2 did not differ, it was 7.1±6.6 and 7.0±6.2 years respectively (р>0.05). Higher proportions of patients with nail psoriasis were male, disabled from working and chronic smokers compared to patients without nail psoriasis: 51.9% vs 44.1% (р=0.013), 37.20% vs 26.40% (р<0.01) and 18.9% vs 8.7% (р<0.01) respectively. Patients with nail psoriasis had more severe erosive peripheral arthritis compared to patients without nail psoriasis. Median TJC was 8 [4–15] vs 5 [2–12] (р=0.002), SJC – 5 [1–9] vs 2 [0–7] (р=0.003), and erosive radiographic arthritis of feet was found in 45.0% vs 31.2% of patients (р=0.003) respectively. Group 1 patients had higher disease activity measured by DAPSA – 25 [15–39] vs 20 [12–33] (p=0.001) and ASDAS-CRP – 3.1 [2.2–4.0] vs 2.8 [1.8–3.5] (р=0.004), compared to group 2 patients. Patients with nail psoriasis had higher frequency of heel enthesitis and dactylitis; axial disease was diagnosed more often among them, compared to patients without nail psoriasis. Heel enthesitis was detected in 53 (17.0%) vs 28 (10.1%; р=0.016), dactylitis – in 76 (24.4%) vs 46 (16.7%; р=0.022), spondylitis – in 109 (35.0%) vs 73 (26.4%; р=0.025) patients respectively. Patients in group 1 had worse skin psoriasis than in group 2. Patients with nail psoriasis significantly more often had moderate and severe skin psoriasis according to BSA, compared to patients without nail psoriasis (39.9% vs 26.1% and 14.8 vs 1.1% respectively; р<0.01 for both comparisons); group 2 patients significantly more often had limited skin psoriasis compared to group 1 patients – in 72.8% vs 45.3% of cases respectively (р<0.01). Median PASI index in groups 1 and 2 was 6 [2–14] vs 3 [1–6] respectively (р<0.01). Group 1 patients gave worse assessment of their disease than group 2 patients; median PGA was 50 [40–70] mm vs 50 [30–65] mm VAS respectively (р=0.044). Less patients with nail psoriasis compared to patients without nail psoriasis had achieved MDA throughout the whole study. At the first visit MDA was detected in 3% vs 9% (р=0.006) of patients, at the second – in 12% vs 27% (р<0.001), at the third – in 14% vs 28% (р=0.011), at the fourth – in 17% vs 38% (р<0.001) and at the fifth in 27% vs 52% (р=0.004) of patients respectively. Patients with and without nail psoriasis were given equivalent therapy with diseasemodifying antirheumatic drugs (DMARDs) and biological agents (bDMARDs). DMARDs were given to 78.2% and 80.1% of patients respectively (р>0.05), it was mostly methotrexate (MTX); MTX was used in 66.0% and 64.1% of cases respectively (р>0.05). bDMARDs were prescribed to 22.1% and 28.3% (р>0.05) of patients, including tumour necrosis factor (TNF) inhibitors – in 67% and 63% of cases, interleukin (IL) inhibitors – in 33% and 37% of cases (р>0.05 for both comparisons). Taking into account the similar disease duration and equivalent therapy in both groups, it could be concluded that patients with nail psoriasis achieved MDA less frequently due to greater disease severity.Conclusion. Nail involvement is identified in more than half (53%) of PsA patients of the Russian Psoriatic Arthritis Registry. Nail psoriasis is associated with significantly worse disease status as measured by severe peripheral arthritis, enthesitis, dactylitis, spondylitis and skin lesions; higher frequency of erosive arthritis was detected in this category of patients. Patients with nail psoriasis had achieved MDA less frequently compared to patients without nail psoriasis. Nail involvement is associated with worse response to therapy and patients’ disability. These data emphasize the importance of accurate diagnostics of nail psoriasis and optimization of treatment approach, including “targeted” therapy.

Background:Limited data are available regarding the burden of nail disease in psoriatic arthritis (PsA). The latest data show that nail involvement in PsA patients (pts) is associated with significantly more severe disease status (1).Objectives:To analyze, in clinical practice, the association of nail psoriasis with disease activity, quality of life, and work productivity in PsA pts.Methods:588 pts (M/F–277 /311) with PsA according to CASPAR criteria were included in the study. Data were collected from 43 rheumatology clinics from different regions of the Russian Federation. Pts’ age 48.6±0.5 years (yrs), disease duration 7.0±0.3 yrs. Pts underwent standard clinical examination of PsA activity. Pts were split into two groups (gr.): those with nail psoriasis – gr.1, and those without it – gr.2. Demographics, disease activity, quality of life, and work productivity were compared between pts with and without nail psoriasis using Pearson’s chi-square test and Mann–Whitney U test.Results:Gr.1 includes 312 (53.1%) cases, gr.2 – 276 (46.9%) cases. More pts in gr.1 were males (51.9% vs 44.1%, р=0.013), disabled at work (37.20% vs 26.40%, р=0.000), chronic smokers (18.9% vs 8.7%, р=0.000) and with axial PsA disease signs according to physician (35.0% vs 26.4%, р=0.025) compared to pts in gr.2. Pts in gr.1 had higher tender and swollen joint counts: 8 [4-15] vs 5 [2-12] (р=0.002) and 5 [1-9] vs 2 [0-7] (р=0.003) respectively. Gr.1 pts had higher disease activity measured by DAPSA 25 [15-39] vs 20 [12-33] (p= 0.001), higher frequency of dactylitis (24.4% vs 16.7% р=0.022) and heel enthesitis (17.0% vs 10.1% р=0.016) respectively, higher frequency of erosive radiographic arthritis of feet (45.0% vs 31.2% р=0.003) compared to gr.2 pts. Pts in gr.1 had worse skin psoriasis measured by Psoriasis Area Severity Index – 6 [2-14] vs 3 [1-6] (р=0.000). Less pts in gr.1 than in gr.2 (27.0% vs 52.0% р=0.004) achieved minimal disease activity (MDA). Pts’ reported outcomes (PRO’s) in gr.1 were worse than in gr.2 in regard to reduced health-related quality of life according to PsAID (4.9±2.3 vs 4.0±2.3, р=0.040) and to EQ-5D (0.56±0.19 vs 0.64 ±0.21, р=0.024) questionnaires, overall work impairment (0.0 [0.0-0.3] vs 0.0 [0.0-0.2], р=0.034) and overall activity impairment (0.4 [0.1-0.7] vs 0.3 [0.0-0.5], р=0.006) according to WPAI.Conclusion:Nail involvement in PsA pts is associated with male gender and axial disease. PsA pts with nail involvement are more often disabled, more often are chronic smokers, have significantly worse disease status as measured by disease activity; they are more likely to have more severe (erosive) peripheral arthritis of feet, higher frequency of heel enthesitis and dactylitis, higher psoriasis disease severity, lower frequency of MDA achievement, and worse quality of life and work productivity according to PRO’s. Detection of nail involvement is critical for choice of treatment approach and better outcomes.References:[1]Mease PJ et al.J Rheumatol, 2020Disclosure of Interests:None declared.

Background:PsA patients (pts) have an increased risk of cardiovascular (CV) and metabolic (Met) disorders due to the combination of inflammation and increased prevalence of traditional CV risk factors. Only limited data are available on Russian PsA pts. Data was collected from 25 rheumatology clinics of the Russian FederationObjectives:to study, in clinical practice, the prevalence of obesity and its association with PsA activity, CV/Met comorbidities and PROsMethods:614 (M/F=331(54%)/283(46%) PsA pts fulfilling the CASPAR criteria were included from the RU-PsART cohort. Mean age 45.2±0.52 yrs, PsA duration 5.7±0.27 yrs, PsO duration 15.71±0.56 yrs, DAPSA 28.79±0.75. At baseline (BL) PsA activity was evaluated by Tender Joint Count (TJC68), Swollen Joint Count (SJC66), PGA, physician global assessment by Visual Analog Scale (VAS), DAPSA; PROs according to PtGA VAS, PtPain VAS, HAQ, Work Productivity and Activity Index (WPAI) and Body Mass Index (BMI, kg/m2) were calculated. All pts were split into three groups by BMI (kg/m2): normal<25 (I group), overweight 25-30 (II group), obese>30 (III group). M±m, %, Me [Q25; Q75], χ2or Fischer’s exact tests were performedResults:At BL the BMI was 27.7±0.23 kg/m2with the following BMI categories: normal - 213 pts (34.7%), overweight - 214 pts (34.8%) and obese - 187 (30.5%). Increased BMI was observed in 65.3% of PsA pts. In all groups, comorbidities were found in 297 out of 614 pts (48%): arterial hypertension in 190 (64%), diabetes mellitus in 44 (14.8%), Met syndrome in 36 (12.1%), Coronary Heart Disease in 22 (7.4%). CV and Met disorders were significantly more common in obese pts with BMI>30 compared to overweight pts and to normal BMI pts; female prevailed (Table 1).Table 1.CV/Met comorbidity in three groups, n (%).I groupBMI<25 kg/m2II groupBMI 25-30 kg/m2III groupBMI>30 kg/m2pArterial hypertension28(13.2)55(25.7)85(46.5)р<0.0001*Diabetes mellitus015(7)25(14)р<0.0001**Metabolic syndrome0(0)6(2.8)23(12.8)р<0.0001**Coronary heart disease2(0.9)6(2.8)10(5.6)р<0.026****III vs I and II groups, ** III vs II, *** III vs I groupAt BL pts with BMI>30 had higher PsA activity by DAPSA, HAQ, daily activity impairment by WPAI, PtPin compared to I and II groups (table 2).Table 2.PsA activity and PROs based on BMI categories.I groupBMI<25 kg/m2II groupBMI 25-30 kg/m2III groupBMI>30 kg/m2pDAPSA22.7 [14.7; 35.8]24.9 [13.5; 38.5]27 [17.2; 44.4]р<0,05*HAQ0.9 [0.5; 1.3]0.9 [0.5; 1.3]1 [0.8; 1.6]р<0,05*Daily activity impairment0.3 [0; 0.5]0.3 [0; 0.5]0.4 [0; 0.6]р<0,05*PtPain, mm VAS50 [30; 66.5]50 [30; 68]50 [40; 70]р<0,05***p<0.05 III vs I and II groups, ** p<0.05 III vs II groupConclusion:In clinical practice, BMI increase was found in the majority of PsA pts. Obesity was associated with higher PsA activity, more prevalence of CV/Met disorders and worse PROs. Obesity requires a change of the pts’ lifestyle, nutrition correction and a right choice of therapyDisclosure of Interests:Yulia Korsakova: None declared, Elena Loginova Speakers bureau: Janssen, ELENA GUBAR: None declared, Elizaveta Vasilenko: None declared, Aleksey Vasilenko: None declared, Natalia Kuznetsova: None declared, Irina Patrikeeva: None declared, Tatiana Korotaeva Grant/research support from: Pfizer, Consultant of: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Speakers bureau: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Alexander Lila: None declared, Evgeny Nasonov: None declared

Objective: to compare the clinical efficacy in real clinical practice of the targeted synthetic disease-modifying antirheumatic drug (sDMARD) tofacitinib (TOFA) and the biologic DMARD (bDMARD), an inhibitor of tumor necrosis factor alpha (TNFα), adalimumab (ADA) in patients with psoriatic arthritis (PsA), included in the Russian nationwide register of patients with PsA.Patients and methods. The study included 77 patients with PsA (43 men and 34 women) who met the CASPAR criteria and were observed in the Russian nationwide register. Patients were divided into two groups depending on the treatment. Group 1, in which oral TOFA was prescribed, 5 mg 2 times a day, included 41 patients: 24 (58.5%) men and 17 (41.5%) women, the median age was 41 [34; 50] years, the median duration of PsA was 72 [35; 120] months. Group 2, in which subcutaneous ADA was used, 40 mg every 2 weeks, included 36 patients: 19 (52.8%) men and 17 (47.2%) women, the median age was 44 [34; 51] years, the median duration of PsA was 59 [22; 102] months. Combination therapy, including methotrexate (MT), received 80.5% of patients in the TOFA group and 52.8% of patients in the ADA group. At the beginning of the study and every 6 months further, the activity and efficacy of PsA therapy were assessed in all patients according to DAPSA and criteria for minimal disease activity – MDA (number of painful joints ≤1, number of swollen joints ≤1, PASI ≤1 or BSA ≤3 , pain score ≤15, patient's general assessment of disease activity ≤20 mm on a visual analogue scale, HAQ ≤0.5, enthesitis ≤1), dynamics of BASDAI and BSA were also assessed. The number of patients who achieved remission (DAPSA ≤4) or MDA (5 criteria out of 7) during therapy with TOFA and ADA was determined.Results and discussion. Before the start of the therapy in the 1st group, the median DAPSA was 44.2 [37.8; 55.3]: moderate PsA activity was in 5 (12.2%) patients, high in 36 (87.8%) patients. In group 2, the median DAPSA was 35.8 [21.1; 52]: low activity was detected in 3 (8.6%), moderate – in 11 (31.4%), high – in 21 (60%) patients (data from 35 patients was available). 6 months after the start of treatment in patients of the 1st and the 2nd group, there was a significant decrease in all indicators of PsA activity compared to the baseline. The median DAPSA was 11 [4.3; 17.3] and 9.1 [6; 19.6]; remissions according to DAPSA reached 11 (26.8%) and 6 (20.8%) patients, respectively, low activity – 15 (36.6%) and 13 (44.8%), MDA – 16 (40%) and 9 (30%). The number of patients with dactylitis in the 1st and in the 2nd group significantly decreased: from 22 (53.7%) to 5 (13.2%) and from 13 (36.1%) to 6 (20%), respectively. Median HAQ decreased from 1 [0.625; 1.5] to 0.5 [0; 0.875] and from 0.875 [0.5; 1.38] to 0.5 [0; 0.875]; median BASDAI – from 6 [4.2; 7] to 1.4 [0.6; 3.2] and from 4.4 [1.9; 5.8] to 3 [0.8; 4.5], respectively. In group 1, the number of patients with BSA> 3% decreased from 16 (39%) to 8 (26.7%; p<0.225), and in group 2, due to insufficient data (5 patients), we failed to evaluate BSA dynamics.Conclusion. In real clinical practice TOFA and ADA both had comparable efficacy on all clinical manifestations of PsA: after 6 months of therapy, most patients with PsA achieved MDA, low disease activity and remission according to DAPSA and BASDAI.

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