Glucocorticoids (GC) continue to be indispensable drugs for the treatment of systemic lupus erythematosus, since there are no other alternatives that can so quickly stop the activity of the disease. However, the accumulation of irreversible damage to organs (cataracts, osteoporosis, diabetes mellitus, etc.) significantly limits their use. This article examines the current views of leading rheumatologists on the treatment with GC in patients with SLE, namely three main principles: a) the use of pulse therapy with 6-methyl prednisone to induce remission not only in severe cases of the disease; b) limiting the initial doses of prednisone to <30 mg/day, with a rapid decrease to maintenance dose <5 mg/day; c) a personalized approach to the GC withdrawal strategy. Long-term hydroxychloroquine therapy and early implementation of immunosuppressive therapy will help achieve these goals.

Oral and ocular manifestations of Sjögren’s disease (SjD) were first described over 100 years ago, but SjD was recognized as an independent nosology in 1965. However, currently the diagnosis and treatment of this disease still pose significant difficulties. The second part of the article presents the most common and significant myths in clinical and laboratory manifestations, lymphoproliferative complications, and treatment of SjD.

The work of recent decades has changed the idea that axial spondylitis (axSpA) is an exclusively “male” disease. However, at present, when deciding on further treatment tactics, gender differences in the course of the disease and response to treatment are not taken into account. The aim – to study gender differences in disease activity indices in patients with axial spondylitis. Material and methods. The study included 108 patients who met the 2009 ASAS (Assessment of SpondyloArthritis International Society) criteria for axSpA or the modified New York criteria for ankylosing spondylitis (AS) of 1984. The mean age of patients at inclusion in the study was 35.4±10.8 years, most of them were men – 62 (57.4%). The AS criteria were met by 67.2% of women and 88.5% of men. The remaining patients were diagnosed with non-radiographic axSpA. Results and discussion. The duration of the disease did not differ between patients of different sexes (p=0.3): 60.0 [24.0; 96.0] months in men and 42.0 [21.8; 84.0] months in women. HLA-B27 antigen positivity was detected in 36 (78.3%) women and 55 (88.7%) men. Women were more often (p=0.048) diagnosed with arthritis than men: 37 (80.4%) and 39 (62.9%), as well as dactylitis (p=0.01): 15 (32.6%) and 8 (12.9%), respectively. No differences were found between men and women in the frequency of other extraskeletal and extraaxial manifestations of axSpA. Also, no differences were found in the BASFI (Bath Ankylosing Spondylitis Functional Index), MASES (Maastrich Ankylosing Spondylitis Enthesitis Score) indices and in all domains of the BASMI (Bath Ankylosing Spondylitis Metrology Index) index. In men, the C-reactive protein level was significantly higher than in women (p=0.03). At the same time, the disease activity according to the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) index, as well as the patient’s pain assessment indicators, global assessment of general well-being according to the numeric rating scale in women of the study group were higher than in men. The average anxiety value according to the HADS (Hospital Anxiety and Depression Scale) scale was higher in women (p=0.01) than in men – 9.0 [6.0; 10.0] and 5.0 [2.0; 8.0], respectively. The average depression value according to the HADS scale did not differ between the groups (p=0.3): 5.5 [3.0; 6.0] and 3 [1.0; 5.6], respectively. Conclusions. The revealed clinical heterogeneity of axSpA manifestations in men and women, the peculiarities in pain assessment by patients of different genders, allow us to state that gender influences the interpretation of disease activity. Further studies are needed to study gender differences in patients with axSpA to optimize treatment approaches and assess its effectiveness.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that affects many organs and is characterized by a complex interaction of immune cells, factors and pathways leading to various clinical manifestations. During the disease duration, skin involvement occurs in about 75–80% (up to 20–25% in the debut) of patients with SLE. This article describes two clinical cases with rare chronic skin involvement in patients with SLE.

Smoking is one of the main proven environmental factors that worsen the course and effectiveness of rheumatoid arthritis (RA) treatment. The aim – to evaluate the effect of smoking cessation on rheumatoid arthritis activity, pain, and quality of life in patients during a one-year prospective follow-up. Material and methods. 194 patients included in the prospective intervention cohort (individual preventive counseling, “Smoking Cessation School”). The follow-up period was 12 months. Demographic and medical history data, information about comorbidity, and smoking status were analyzed. The activity of RA (Disease Activity Score 28 (DAS28) with erythrocyte sedimentation rate) and the intensity of pain (using visual analogue scale (VAS)) were evaluated at baseline and after 3, 6, and 12 months. The quality of life was assessed at the 6th and 12th months of follow-up using the SF-36 (Short Form 36) questionnaire and the HAQ (Health Assessment Questionnaire). Results. At the time of baseline, there were no differences in the groups of those who continue to smoke and those who quit in the future in terms of activity RA, HAQ and VAS (all p>0.05). In patients in the smoking cessation group, disease activity was significantly lower by 6 months (p=0.000002), as were the HAQ and VAS values after 6 and 12 months (all p<0.05). By the end of the follow-up year, remission and low RA activity were recorded in 9 (40.9%) of those who quit smoking and 20 (13.8%) who continued (p=0.002). In patients who had given up smoking, physical functioning, role-playing physical functioning, and general health were significantly better (p=0.015, p=0.013, and p=0.026, respectively) at the time of a baseline. In all domains of the SF-36 questionnaire, at 6 and 12 months of follow-up were statistically significantly better for those who stopped smoking (all p>0.05). Conclusion. The study shows the need to develop and implement educational programs on smoking cessation in RA in clinical practice.

Introduction. Chronic inflammation in rheumatoid arthritis (RA) is one of the causes of activation of bone resorption, occurrence of erosive changes, disruption of microarchitecture, bone mineral density (BMD) decrease and increased risk of vertebral and peripheral bone fractures. The aim – to study the dynamics of bone mineral density, vertebral deformations and degenerative changes in the lumbar spine in patients with rheumatoid arthritis during long-term prospective observation. Materials and methods. A prospective multi-year cohort study, the duration of which was 9.7±1.7 years, included 151 women with RA aged 53.9±9.2 years with a reliable diagnosis established at the age of 41.9±12.5 years. All patients underwent clinical, laboratory and radiological examination (X-ray densitometry of the lumbar spine (L1–L4), femoral neck (FN) and total hip (TH), X-ray morphometry of the spine using the Genant method, assessment of degenerative changes in the lumbar spine) in dynamics. Results. A BMD decrease in FN and TH and stabilization in L1–L4 were established; in patients over 55 years of age it was an increase in BMD in L1–L4 and a decrease in FN and TH; a decrease in BMD in all studied skeletal regions in patients under 55 years of age. The appearance or increase in deformations (fractures) of the vertebrae in the thoracic spine was observed in 50 (33%) patients, in the lumbar spine – in 4 (2.6%) patients; a relationship between deformations (fractures) of the vertebrae and an increase in BMD was not established. An increase in degenerative changes in all segments of the lumbar spine was established in patients with pain and a significant increase in L1–L4 BMD. Long-term monotherapy with DMARDs, as well as with biologics, did not have a positive effect on the BMD. Conclusions. A long-term prospective cohort study revealed stabilization of the BMD in L1–L4; its increase in the group of patients with RA over 55 years of age against the background of the appearance or intensification of the initial deformation (fractures) of the vertebrae; and an increase in degenerative changes in all segments of the lumbar spine.

Background. Interleukin (IL) 6 plays an important role in the pathogenesis of comorbid rheumatoid arthritis (RA) depression. IL-6 inhibitors used to treat patients with RA may also have an antidepressant effect. The objective of this study is to evaluate the effectiveness of 24-week interleukin 6 inhibitor therapy with olokizumab (OKZ) in combination with or without psychopharmacotherapy (PPT) in patients with moderate to high rheumatoid arthritis activity. Material and methods. A total of 125 patients with RA were included, 102 (81.6%) of them being women. The average age of the patients was 48.5±12.6 years; the majority of the patients (86.4%) had high RA activity and had shown ineffectiveness with stable 12-week therapy using conventional synthetic disease modifying antirheumatic drugs (csDMARDs). Additionally, 34 (27.2%) patients had shown inefficiency with one or more biological DMARDs. According to the International Classification of Diseases, 10th revision (ICD-10), a psychiatrist diagnosed varying severity of depression (chronic or recurrent) in all patients during a semi-structured interview. At week 0, all patients were randomized using sequential numbers in a 2:2:1 ratio into one of three groups: in the group 1, patients received csDMARDs+OKZ 64 mg subcutaneously once every 4 weeks (q4w) (n=49); in the group 2, patients received csDMARDs+OKZ 64 mg subcutaneously q4w along with psychopharmacotherapy (PPT) (n=51); in the group 3, patients received csDMARDs+PPT (n=25). The study duration was 24 weeks. The severity of depression was assessed using the PHQ-9 (Patient Health Questionnaire 9) and MADRS (Montgomery – Åsberg Depression Rating Scale) scales; while anxiety was assessed using the HAM-A (Hamilton Anxiety Rating Scale) scale. Projective experimental psychological techniques were also used. Results. After 12 and 24 weeks of therapy, a significant decrease in the severity of depression and anxiety was observed in all groups of patients. However the differences between the final and initial values of the scales filled in by a psychiatrist were statistically significantly greater (p<0.001) in the groups of patients receiving PPT: in the group 2 (ΔMADRS24–0=–20.2±6.57; ΔHAM-A24–0=–13.2±5.68) and group 3 (ΔMADRS24–0=–17.8±4.73; ΔHAM-A24–0=–13.4±4.41), compared with the group 1 (ΔMADRS24–0=–5.42±7.14; ΔHAM-A24–0=–4.58±6.80). There were no significant differences between the groups according to the PHQ-9 depression questionnaire (respectively, in group 1, ΔPHQ-924–0=–4.89±4.87; in group 2, ΔPHQ-924–0=–6.73±4.97; in group 3, ΔPHQ-924–0=–7.26±5.58), despite a greater decrease in the severity of depression observed in the groups with PPT. According to a semi-structured interview with a psychiatrist and in accordance with the criteria of ICD-10 the proportion of patients without depression 24 weeks after the start of therapy was significantly higher in the groups receiving PPT: 84.3% in group 2, 100% in group 3, and 16.3% in group 1. Conclusion. In patients with moderate/high RA activity and comorbid depression, OKZ without PPT can lead to a decrease in the severity of depression or, less often, to a complete regression of depressive symptoms, mainly in patients with minor depression. OKZ therapy without PPT also reduces the severity of anxiety, but does not eliminate it completely. The combination of OKZ and PPT is optimal for achieving complete regression of depression and anxiety in this category of RA patients.

“Rice bodies” symptom are a secondary clinical manifestation of a number of pathologies involving the synovial tissue. The conditions associated with this phenomenon include rheumatoid arthritis, tuberculosis, juvenile idiopathic arthritis, infectious arthritis, systemic lupus erythematosus, sarcoidosis, and reactions to orthopedic implants. It is possible that other nosological entities may be involved, although no data is currently available. “Rice bodies” present as multiple round-shaped bodies located both intra-articularly and periarticularly in synovial bursae and tendon sheaths. The etiology of this condition remains unknown, reliable statistics on its prevalence are not found in the literature, and its pathogenesis remains controversial. Clinically, the condition may be associated with pain and/or functional limitations, but it can also be asymptomatic and discovered incidentally. The optimal method for diagnosis is magnetic resonance imaging, while the preferred treatment is surgical extraction of the structures along with the adjacent components of hypertrophied synovium, followed by mandatory histopathological examination and conducting differential diagnostics with synovial chondromatosis and villonodular synovitis. These patients require a team-based multidisciplinary approach led by a specialist responsible for treating the underlying disease.

The LUPUS 2025 Congress showcased cutting-edge data on systemic lupus erythematosus (SLE). Highlights included an updated step-wise treatment algorithm for cutaneous lupus, the proposal of an early triple-therapy regimen for lupus nephritis with standardized histologic response criteria, and the identification of novel biomarkers that enhance patient stratification. In addition, an expert consensus provided therapeutic guidance for 24 rare SLE manifestations.