Therapy

Systemic lupus erythematosus (SLE) is a common autoimmune disease that primarily affects females of reproductive age. In recent years, the risks of perinatal pathology in patients with SLE have been increasingly discussed.

The aim: to assess the prevalence of SLE in females with infertility according to I.I. Mechnikov North-Western State Medical University’s Registry.

Material and methods. Retrospective analysis of 129 consultations of female patients aged 18–45 years with a history of reproductive problems and SLE symptoms. Patients with a previously established diagnosis of SLE or another immune-mediated inflammatory disease (IMID), as well as those with confirmed acute or recurrent chronic infectious disease, were excluded. The study consisted of two visits and laboratory testing (determination of antinuclear factor (ANF) titers and antibodies (AB) to extractable nuclear antigens.

Results. 129 female patients who met all inclusion/exclusion criteria were screened in the study. A total of 104 (81%) study subjects had a previous pregnancy. Spontaneous miscarriages were the most common obstetric pathology (49%). A positive ANF titer was observed in 84 patients (65%). A positive immunoblot result for extractable nuclear antibodies was observed in 16 patients (19%). The study identified 12 patients (18%) who were diagnosed with SLE.

Conclusion. The study identified 12 patients (18%) who were diagnosed with SLE basing on the 2019 EULAR/ACR criteria. The most common obstetric pathology was recurrent miscarriage (49%). Thus, the hypothesis that unexplained infertility and recurrent miscarriage may be a clinical manifestation of unverified IMID was confirmed. Therefore, females with unexplained infertility should be advised to consult a rheumatologist and undergo specific immunological testing to exclude IMID.

Long-term (more than 3 months) use of glucocorticoids (GCs) in patients with rheumatoid arthritis (RA) is the most common cause of adrenal insufficiency (AI). High-performance liquid chromatography (HPLC) allows for the determination of a spectrum of steroid hormones at low concentrations, minimizing cross-reactions, which opens up new possibilities for an objective estimation of adrenal function.

The aim: to determine the dynamics of the adrenal steroid hormone spectrum in patients with RA taking long-term systemic GCs and to identify the most informative GCs for AI diagnosis.

Material and methods. The study included 34 patients with RA (mean age 58.1 ± 9.6 years; 76.5% females) receiving combination therapy with olokizumab, methotrexate, and prednisolone. The duration of continuous prednisolone treatment was 41 [21.5; 51.0] months at a dose of 8.75 [5; 10] mg daily. Steroid profile was assessed by HPLC at two checkpoints: after achieving low RA activity and after 6 months while reducing GC dose.

Results. Cortisol deficiency was detected in 14.7% of patients, and cortisone levels were decreased in 47.1%, which could serve as laboratory evidence of AI presence. A repeat study after 6 months while reducing/discontinuing GC dose revealed a statistically significant increase in cortisone (p = 0.002) and corticosterone (p = 0.025) levels in 73.5% of patients. Complete withdrawal of systemic GCs was achieved in 73.5% of patients, while disease activity remained low.

Discussion and conclusion. HPLC method for assessing the steroid profile enables the timely diagnosis of rheumatoid arthritis and an objective estimation of adrenal function recovery with a reduction of glucocorticoid dose. Achieving stable remission or low RA activity with effective therapy allows for the successful reduction and withdrawal of glucocorticoids use, with restoration of adrenal function under clinical and laboratory monitoring.

In recent years, increasing attention has been paid to the index non-high-density lipoprotein cholesterol (non-HDL-cholesterol), an elevated level of which is considered as a factor for the progression of atherosclerotic cardiovascular and renal diseases.

The aim: to assess the incidence and clinical and functional manifestations of elevated non-HDL-cholesterol in patients with chronic kidney disease (CKD).

Material and methods. This retrospective analysis included data from 553 patients with CKD aged 18–70 years (mean age 37.7 ± 12.4 years). All subjects underwent clinical laboratory testing, including a blood lipid profile. Non-HDL-cholesterol level was defined as the difference between total cholesterol and high-density lipoprotein cholesterol; non-HDL-cholesterol was considered as elevated if its level was ≥ 3.7 mmol/L.

Results. Elevated non-HDL-cholesterol was detected in 57.3% of patients with CKD (56.3% in male and 59.2% in female individuals). The average non-HDL-cholesterol level was 4.76 mmol/L (4.84 mmol/L in males and 4.59 mmol/L in females). The highest frequency of this index increase was fixed at CKD stages C3B (70.0%), C2 (68.1%), C3A (65.5%) and C1 (58.5%). In males, its high values were more often recorded at stages C1 (16.8%), C2 (13.2%) and C5 (10.2%), and in females – at stages C2 (14.1%), C5 (11.4%) and C1 (10.8%). Median non-HDL-cholesterol values were statistically significantly higher in the early stages of CKD. Reliable correlations were established between the level of non-HDL-cholesterol and systolic blood pressure (r = -0.099), hemoglobin content (r = 0.266), platelet number (r = 0.235), erythrocyte sedimentation rate (r = 0.370), fibrinogen levels (r = 0.613), total protein (r = -0.575), albumin (r = -0.558), creatinine (r = –0.216), estimated glomerular filtration rate (r = 0.236) and daily proteinuria (r = 0.501).

Conclusion. Patients with CKD often have elevated levels of non-HDL-cholesterol, which likely reflects the activity of the pathological process in renal tissue. The identified associations between non-HDL-cholesterol levels and clinical and laboratory parameters confirm the advisability of their assessment as part of routine follow-up to slow the progression of renal failure and reduce the risk of cardiovascular complications.

Comorbidity of axial spondyloarthritis (AxSpA) and Crohn’s disease (CD) is conditioned by common mechanisms within the concept of intestinal-vascular barrier impairment. However, the role of noninvasive markers in assessing the correlation between intestinal inflammation and endothelial dysfunction in this comorbidity requires clarification.

The aim: to study the significance of fecal markers of inflammation and permeability in case of AxSpA, CD, and their combination.

Material and methods. 78 patients were examined: 22 with a combination of AxSpA and CD (group A), 29 with isolated AxSpA (group B), and 27 with isolated CD (group B). All the participants were assessed for fecal calprotectin (FC), zonulin, eosinophilic neurotoxin, serum hyaluronan, and syndecan-1concentrations using enzyme-linked immunosorbent assay (ELISA) methodic. The state of endothelial glycocalyx (EGc) and microcirculation were assessed using dark-field microscopy. Statistical analysis was supplemented by the construction of link graphs (systemic reconstruction).

Results. FC levels were significantly higher in groups A and B comparatively to group B (p = 0.013). In group A, a correlation was found between FC levels and markers of EGc thinning and decreased perfusion. Systemic reconstruction identified FC as a systemically important indicator in all groups. Common correlates of FC level were systemic inflammation and microcirculatory disorders (EGc thinning, decreased capillary count). The relationship between intestinal inflammation and functional status is specific to both forms of AxSpA. However, in case of CD-associated form, a unique direct correlation between FC and zonulin level and the presence of syndesmophytes has been established, distinguishing this phenotype from isolated AxSpA.

Conclusion. FC serves as an integral marker reflecting local intestinal inflammation and systemic dysfunction of the EGc. Study results confirm the role of gut-vascular barrier in the pathogenesis of comorbidity. Gut-vascular barrier dysfunction is of key importance in CD-associated AxSpA. A comprehensive assessment of biomarkers is promising for phenotyping and personalized therapy for these patients.

Article contains the results of a cross-sectional study assessing the contribution of single nucleotide polymorphisms to the development of osteoporosis (OP) in postmenopausal female individuals.

The aim: to assess the detection rate of single nucleotide polymorphic variants of candidate genes for osteoporosis (OP) and their contribution to the development of this disease in postmenopausal females.

Material and methods. The study included 78 postmenopausal patients: Group 1 – 41 patient with OP; Group 2 – 37 females who did not meet the criteria for this diagnosis. All participants were assessed for single nucleotide polymorphisms of IL6, RANKL, COL1A1, VDR genes using real-time polymerase chain reaction.

Results. According to the main clinical characteristics, patients with OP had lower values of anthropometric parameters (body weight, waist and hip circumference), earlier age of menopause, and a significantly higher history of both osteoporotic and any other fractures. Females without OP were significantly more likely to be obese and more often used calcium channel blockers. The study did not reveal statistically significant intergroup differences in the frequency of detection of polymorphic variants of genotypes. A two-locus model was constructed, it included polymorphisms rs9594759 of RANKL gene and rs1107946 of COL1A1 gene; its sensitivity was 60%, specificity – 71%. The most significant contribution to the development of osteoporosis is made by the rs9594759 polymorphisms of RANKL gene and rs1800012 polymorphisms of COL1A1 gene, as well as the association of the rs1107946 polymorphisms of COL1A1 gene and rs9594759 polymorphisms of RANKL gene.

Conclusion. Multilocus analysis and prognostic model based on a combination of various polymorphic genes can assess the risk of developing osteoporosis in postmenopausal female patients.

Heterogeneity of systemic scleroderma (SSD) clinical manifestations with lesions of connective tissue, musculoskeletal system, and internal organs necessitates regular patient monitoring and ongoing immunosuppressive therapy with genetically engineered biological agents. However, such kind of treatment has side effects and cannot fully control the disease or reduce the risk of fatal outcomes, especially in patients having diffuse form of SSD. This category of patients often requires high-dose immunosuppressive therapy followed by autologous hematopoietic stem cell transplantation (HIST-ATHSCT), which allows for long-term drug-free remission, regression of clinical manifestations, and a reduced risk of mortality from internal organ damage. Current article provides a detailed overview of current international guidelines for patient eligibility for HIST-ATHSCT, as well as the required pre-procedure examination. The available data will allow for the future development of domestic patients’ selection criteria for SSD and also the supplementation of clinical guidelines to improve treatment outcomes of this severe autoimmune pathology.

During the autumn and winter period, outpatient physicians often encounter patients complaining of a sore throat, cough, and hoarseness. However, these symptoms are not always associated with infectious diseases. Such kind of patients are often subsequently diagnosed with laryngopharyngeal reflux (LPR), which can be an extraesophageal manifestation of gastroesophageal reflux disease (GERD). In real-world clinical practice, diagnosing LPR presents significant challenges due to the lack of pathognomonic clinical signs and a universal diagnostic tool. The most difficult for diagnosing are LPR cases without typical GERD symptoms. In this cohort of patients, developing a method for diagnosing extraesophageal GERD manifestations by measuring pepsin and bile acid levels in saliva may be a promising approach. Combined use of proton pump inhibitors with an esophageal protector is the most effective approach to GERD-associated LPR treatment.

ANCA associated vasculites (AAV) are rare and potentially fatal diseases, especially when they are beginning with diffuse alveolar hemorrhage. Current article presents a complicated case of AAV diagnosing as bilateral pneumonia, when a 38-year-old female patient had a fulminant onset of vasculitis accompanied by massive hemoptysis and respiratory failure. Ineffectiveness of antibiotics and appearance of extrapulmonary symptoms (hematuria, cutaneous vasculitis, sinusitis) prompted the physicians to change their diagnostic approach. After excluding infections, oncologic pathology and verifying microscopic polyangiitis (specific myeloperoxidase antibody levels > 187 U/ml), the patient was prescribed induction therapy with methylprednisolone and cyclophosphamide pulses, which produced a rapid positive effect. This clinical observation highlights the importance of including AAV in the differential diagnosis list in case of diffuse alveolar hemorrhage of unknown etiology. A comprehensive estimation of multisystem damage and early immunological testing are essential for the timely diagnosis of AAV, while standard therapy is highly effective even in fulminant cases of the disease.

Current article discusses rare extraintestinal manifestations of inflammatory bowel diseases – interstitial lung diseases and renal damage in IgA variant of nephropathy. The frequency of such manifestations, diagnostic principles, and treatment approaches are discussed. A clinical case of Crohn’s disease with interstitial lung disease and IgA nephropathy is introduced, and the peculiarities of therapy selection for a specific patient are discussed.

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic systemic inflammation and progressive joint destruction, extra-articular tissue and organ damage, progressive disability, risks of worsening comorbid conditions, deterioration in life quality, and premature mortality. Failure to achieve disease control or sustained remission with standard disease-modifying drugs necessitates modification of therapeutic regimens. Current review examines in details the criteria proposed by EULAR working group for identifying patients with difficult-to-treat RA (D2T-RA), and analyzes data from clinical observations, registries, and studies reflecting epidemiological data, possible predictors of development, and clinical subtypes of D2T-RA. The development of generally accepted criteria for identifying patients with refractory RA, new alternative therapeutic approaches, and their inclusion in national clinical guidelines are essential points for solving D2T-RA problem.

Article discusses the most important aspects of the educational process within the framework of therapeutic disciplines in medical universities of the Russian Federation under the specialist programme in the “General medicine” speciality for preparation of a general practitioner (district general practitioner) for practical work. Controversial and unresolved issues are introduced, including the discrepancy between curriculums for teaching internal diseases due to a different number of credit points of workload, the lack of a system of horizontal and vertical continuity of teaching between Departments. Attention is paid to digital educational solutions that create a safe environment for simulating clinical situations of varying complexity, creating cognitive mechanisms of clinical reasoning and ensuring continuity of student training from propaedeutics to outpatient practice. Current and promising areas in this field include the wider use of integrated educational programs as a means of achieving “seamless” teaching, development and implementation of national standards for digital therapeutic education that meet modern clinical medicine requirements, standardization of the content of the disciplines studied in internal medicine direction, and the development of a unified, structured educational program.

In November 2025, a meeting of the Expert Council as part of the XX National Congress of Internal Medicine took place. The discussion was focused on hyperuricemia (HU), an important factor in the development and progression of a wide range of medical diseases that negatively contributes to cardiovascular and overall mortality increasing. Leading Russian specialists in internal medicine discussed the role of elevated serum uric acid levels in the etiopathogenesis of socially significant chronic non-communicable diseases, and outlined key aspects of diagnosis, as well as non-pharmacological and pharmacological treatment of HU. Following the meeting, it was adopted a resolution concerning the necessity to establish a Working Group and develop national clinical guidelines for HU diagnosis and treatment.

Treatment for patients with knee osteoarthritis (OA) is based on a comprehensive approach, specifically the use of non-drug and drug-based treatments. The main pharmaceutical agents include chondroitin sulfate and glucosamine sulfate, injectable hyaluronic acid and bioactive concentrate of small sea fish, antirheumatic drugs (synthetic, targeted, and biological agents, biosimilars), adjuvant therapy (nutraceuticals, vitamins, type II collagen, dietary supplements), and orthobiological methods (the patient’s own cells, biomaterials and drugs, bioimplants) that promote joint restoration without surgical intervention. This article presents a clinical example of the application of an orthobiological method using the domestic biopolymer microheterogeneous collagen-containing hydrogel in a patient with knee OA. The treatment effect was confirmed by clinical and instrumental assessment methods over time.