Systemic Connective Tissue Diseases Research Articles

Advanced Imaging of Gout and Other Inflammatory Diseases Around the Knee.

The knee is one of the most commonly affected joints in the course of inflammatory arthropathies, such as crystal-induced and autoimmune inflammatory arthritis. The latter group includes systemic connective tissue diseases and spondyloarthropathies. The different pathogenesis of these entities results in their varied radiologic images. Some lead quickly to joint destruction, others only after many years, and in the remaining, destruction will not be a distinguishing radiologic feature.Radiography, ultrasonography, and magnetic resonance imaging have traditionally been the primary modalities in the diagnosis of noninflammatory and inflammatory arthropathies. In the case of crystallopathies, dual-energy computed tomography has been introduced. Hybrid techniques also offer new diagnostic opportunities. In this article, we discuss the pathologic findings and imaging correlations for crystallopathies and inflammatory diseases of the knee, with an emphasis on recent advances in their imaging diagnosis.

ВЛИЯНИЕ РЕВМАТОИДНОГО АРТРИТА НА ТЕЧЕНИЕ ЗАБОЛЕВАНИЙ ПАРОДОНТА

The most common chronic systemic autoimmune disease of connective tissue is rheumatoid arthritis, the incidence of which is up to 50% (in Russia). The etiology of rheumatoid arthritis is still not known for certain. Scientists pay special attention to searching and studying the factors influencing the occurrence of this disease. Researchers are interested in periodontitis as a likely factor in the development of rheumatoid arthritis. The literature presents limited data on the study of the characteristics of the course of dental diseases in patients with rheumatoid arthritis, which indicates the need for further study of this issue and clarification of the relationships between the intensity of caries, the condition of periodontal tissues and the temporomandibular joint in this category of patients. The study of these issues is of scientific and practical interest, as it allows us to improve the methods of diagnosis and monitoring of patients with rheumatoid arthritis by a dentist. The purpose of this study is to determine the effect of rheumatoid arthritis on the course of periodontal diseases. Materials and methods. The methodology of the scientific research is based on the analysis of domestic and foreign literature in the eLIBRARY databases; basic and additional methods of examining the patient were carried out. During the clinical examination, we assessed the general condition of the patient with rheumatoid arthritis, his dental and periodontal status. Results and discussion. A clinical examination of a patient with somatic pathology was carried out. Microorganisms of periodontal pockets were determined, the data obtained were compared with a patient who does not have a systemic disease. Conclusions. Patients with rheumatoid arthritis generally have a thin gingival biotype. Immunological parameters of oral fluid (IgA) in rheumatoid arthritis decrease, which indicates a lack of local and general immunity and leads to damage to periodontal tissue. In the future, this scientific research will help us develop optimal methods for diagnosing and treating patients with autoimmune disease.

Can transesophageal echocardiography be safely omitted in patients scheduled for elective ablation of atrial arrhythmias? Data based on the LATTEE registry.

According to the present guidelines, transesophageal echocardiography (TEE) before scheduled catheter ablation (CA) for atrial arrhythmias (atrial fibrillation [AF] or atrial flutter [AFL]) is not deemed obligatory for optimally anticoagulated patients. However, daily clinical practice significantly differs from the recommendations. That study aimed to identify transthoracic echocardiographic parameters that could be useful in revealing patients without left atrial thrombus (LAT), thereby contributing to avoiding unnecessary TEE before scheduled CA. This is a sub-analysis of a multicenter, prospective, observational study - LATTEE registry. A total of 1346 patients referred for TEE before scheduled CA of AF/AFL were included. LAT was present in 44 patients (3.3%) and absent in the remaining 1302, who were younger, more likely to have paroxysmal AF, and displayed sinus rhythm during TEE. Additionally, they exhibited a lower incidence heart failure, diabetes, systemic connective tissue disease, and chronic obstructive pulmonary disease. Furthermore, they had a lower CHA2DS2-VASc score and a higher prevalence of direct oral anticoagulants. Echocardiographic parameters, including left ventricular ejection fraction (LVEF) > 65%, left atrial diameter (LAD) < 40 mm, left atrial area (LAA) < 20 cm2, left atrial volume (LAV) < 113 ml, and left atrial volume index (LAVI) < 51 ml/m2, demonstrated 100% sensitivity and 100% negative predictive value for the LAT absence, and weremet by 417 patients. Additional echocardiographic indices: LVEF/LAD > 1.4, LVEF/LAVI > 1.6 and LVEF/LAA > 2.7 identified an additional 57 patients, bringing the total predicted LAT-free patients to 474 (35%). Simple echocardiographic parameters could help identify individuals for whom TEE could be safely omitted before scheduled for elective CA due to atrial arrhythmias.

Antinuclear antibody (ANA) positivity pattern by line immunoassay in a hospital from eastern India: Update from a laboratory perspective

ABSTRACT Context: The existence of more than one antibody in systemic autoimmune rheumatic diseases (SARDs) or connective tissue disease (CTD) along with features of more than one autoimmune disease (AD) in an individual is suggestive of overlap syndrome (OS). Line immunoassay (LIA) can target many autoantibodies in a single approach, thus making the identification of OS feasible. Aims and Objectives: This study aimed to identify the pattern of distribution of antinuclear antibodies by LIA prevalent in a hospital population in eastern India and identify common forms of SARD in this belt based on laboratory findings. Material and Methods: A total of 1660 samples received for ANA profile testing by LIA were analysed. Statistical Analysis: Factor analysis was performed with factor loading scores used in the k-means algorithm to identify clustering of various autoantibodies. Results: U1-snRNP positivity was the highest at 16.69%, and the least frequent autoantibody noted was anti-Jo-1 at 0.71% positivity. Based on the outcome of factor analysis, three clusters were determined. Cluster 1 showed a predominance of anti-PM/Scl antibodies, cluster 2 showed a predominance of anti-dsDNA, anti-histone, anti-SmD1, anti-nucleosomes, anti-PCNA, anti-Po, anti-SSA/Ro52, anti-SSA-Ro60, anti-SSB/La, anti-Scl-70, anti-Mi-2, anti-Ku and anti-AMA-M2, and cluster 3 showed a predominance of anti-U1-snRNP. Conclusions: Mixed connective tissue disease (MCTD) and overlap syndrome (OS) are prevalent more than pure form of an AD in our study population. OS may be missed out by monospecific immunoassays and hence adds to diagnostic challenges. LIA may be more useful in identifying specific autoantibodies by a single approach rather than monospecific immunoassays in populations after a positive screen by indirect immunofluorescence (IIF).

Clinical observation of a patient with mixed connective tissue disease in an outpatient practice

Systemic connective tissue diseases are a heterogeneous group of diseases with unclear etiology, the pathogenesis of which is represented by an autoimmune process, a heterogeneous clinical picture and a variable course. Classical variants of the disease that do not cause difficulties in their verification are most common in clinical practice. But some patients have signs characteristic of various connective tissue diseases. This combination of symptoms is called mixed connective tissue disease or “cross syndrome” (Overlap-syndrome). The multi-organ nature of the clinical picture of the disease presents a diagnostic difficulty for the clinician and leads to late diagnosis, ineffective therapy, and disability of the patient. The article presents a clinical case of mixed connective tissue disease in a middle-aged patient. An analysis of literary sources, clinical data, and laboratory results was carried out.

Cardiovascular risk and inflammation in a population with autoimmune diseases: a narrative review.

Juvenile Systemic Connective Tissue Diseases (JSCTD) are a heterogeneous group of chronic autoimmune diseases, associated with dyslipidemia and increased cardiovascular risk are related. Studies from the last 10 years, from 2013 to 2022, on lipid profiles in JSCTD were collected. Different studies on lipid profiles in children affected by JSCTD were selected, because the aim is to analyze the cardiovascular risk and the possibility of atherosclerosis in these patients in whom, sometimes, corticosteroid therapies and immunosuppressants increase the state of dyslipidemia. Several studies have shown that autoimmune diseases with an inflammatory substrate also share abnormalities in lipid profile and increased cardiovascular risk. Specifically, associations have been found between Juvenile Systemic Connective Tissue Diseases and elevated triglycerides, TC-C (Total Cholesterol), LDL-C (Low-Density Lipoprotein), low HDL-C (High-Density Lipoprotein), and increased risk of developing diseases such as myocardial infarction, peripheral vascular disease, pulmonary and arterial hypertension, and atrial fibrillation. Supplementation with alpha-linolenic acid (ALA) on the other hand has also been analyzed with positive results in reducing inflammatory parameters, such as IL-6 (Interleukin-6), CRP (C-reactive protein), and fasting glucose, in subjects with dyslipidemia. These observations suggest that supplementation with ALA, an omega-3 precursor, may positively modulate both the inflammatory status and dyslipidemic conditions in patients with autoimmune disorders.

BCD020 rituximab bioanalog compared to standard treatment in juvenile systemic lupus erythematosus: The data of 12 months case-control study.

Systemic lupus erythematosus (SLE) is the most frequent and serious systemic connective tissue disease. Nowadays there is no clear guidance on its treatment in childhood. There are a lot of negative effects of standard-of-care treatment (SOCT), including steroid toxicity. Rituximab (RTX) is the biological B-lymphocyte-depleting agent suggested as a basic therapy in pediatric SLE. To compare the benefits of RTX above SOCT. The data from case histories of 79 children from the Saint-Petersburg State Pediatric Medical University from 2012 to 2022 years, were analyzed. The diagnosis of SLE was established with SLICC criteria. We compared the outcomes of treatment of SLE in children treated with and without RTX. Laboratory data, doses of glucocorticosteroids, disease activity measured with SELENA-SLEDAI, and organ damage were assessed at the time of initiation of therapy and one year later. Patients, treated with RTX initially had a higher degree of disease activity with prevalence of central nervous system and kidney involvement, compared to patients with SOCT. One year later the disease characteristics became similar between groups with a more marked reduction of disease activity (SELENA-SLEDAI activity index) in the children who received RTX [-19 points (17; 23) since baseline] compared to children with SOCT [-10 (5; 15.5) points since baseline, P = 0.001], the number of patients with active lupus nephritis, and daily proteinuria. During RTX therapy, infectious diseases had three patients; one patient developed a bi-cytopenia. RTX can be considered as the option in the treatment of severe forms of SLE, due to its ability to arrest disease activity compared to SOCT.

“Masks” of fever of unknown origin in children

The article presents an analysis of cases of hospitalized children with fever of unknown origin. Purpose: to study the nosological structure of the causes of fever of unknown genesis in hospitalized children. Material and methods: a retrospective analysis of the medical histories of children hospitalized in the pediatric department was carried out for 2022–2023. All children underwent a comprehensive laboratory and instrumental examination. Results: the largest proportion (43,9 %) were school-age children who, in addition to fever, had complaints of weakness (87,8 %) and decreased appetite (85,4 %). Anemia (51,2 %), acceleration of ESR (47,6 %) and an increase in C-reactive protein (45,1 %) were most often recorded in the analyses. The causes of fever of unknown origin in 65,9 % of children were infectious diseases, in 19,5 % — autonomic dysfunction syndrome with a violation of thermoregulation, in 6,1 % — systemic connective tissue diseases, in 4,9 % — oncological pathology, in 2,4 % — inflammatory diseases of the gastrointestinal tract. The results of the study can be applied in pediatric practice, monitoring of children with infectious pathology.

The Contemporary Role of Antinuclear Antibodies in Early Diagnosis of Autoimmune Rheumatic Diseases

Antinuclear antibodies (ANA) in blood serum remain the primary diagnostic screening test for systemic connective tissue diseases. This article presents recent literature findings concerning the utilization of ANA in clinical practice. Specifically, it focuses on interpreting analysis positivity, identifying clinically significant types of fluorescence, and categorizing ANA patterns according to specific nosologies. Recommendations for using the name HEp-2-IIF instead of ANA and reporting the results of indirect immunofluorescence analysis for antinuclear antibodies on HEp-2 cell substrates are described in a standardized way, presenting immunofluorescence patterns together with the nomenclature of antibodies and informing about the subsequent management of the patient. Changes made to pattern classification to distinguish between competent and expert level patterns and to improve the visual separation between nuclear and cytoplasmic HEp-2 patterns are discussed. The need for further study of the prevalence and clinical significance of rare ANA patterns, particularly those directed at the mitotic spindle apparatus (NuMA and MSA-2), is emphasized. Prospects for the study and use of autoantibodies against double-stranded DNA not only in diagnosis but also in the treatment of patients with SLE are noted. It was concluded that there is a need for further clinical research, collection, and arrangement of various models of HEp-2 IIF to facilitate the accurate determination of «criterion level» patterns, increase the possibilities of early diagnosis of rheumatological diseases, and improve the management tactics of patients in this category.

Systemic Connective Tissue Disease and Neuromyelitis Optica Spectrum Disorder Coexistence: A Systematic Review and Meta-Analysis.

Several results support the hypothesis that a group of pathologies falling within the Neuromyelitis Optica Spectrum Disorders (NMOSD) diagnostic criteria may coexist with Connective Tissue Diseases (CTD) in patients with a high susceptibility to autoimmune conditions. However, the relationship between NMOSD and rheumatologic diseases deserves further investigations to clarify all clinical aspects of this coexistence. We designed a systematic review and a proportional meta-analysis to estimate the association between CTD and MNOSD, with the aim of helping to plan the best strategy to achieve the most significant public health benefit for these conditions. We conducted a systematic review of the literature published until February 2023, searching in four databases: PubMed, Web of Science, EmBase, and OVID. Then, we conducted a random-effects proportional meta-analysis and assessed the risk of bias of the included studies using the Joanna Briggs Institute checklist. The literature search yielded an overall result of 3176 publications (272 from PubMed, 880 from Web of Science, 634 from EmBase and 1390 from OVID). Of these, 29 were included in this systematic review. Analyzing studies that recruited unselected patients with Systemic Lupus Erythematosus (SLE) and Sjogren Syndrome (SjS), the pooled percentages of NMOSD overlapping were 0.6% (95% Confidence Interval [95% CI]: 0.1%-1.4%,) and 6.5% (95% CI: 4.7-8.6), respectively. Studies enrolling rheumatologic patients with nervous system symptoms involvement reported higher percentage of NMOSD (i.e., among SjS patients, a pooled percentage of 26.5%, 95% CI: 5.5-54.6%, was found). Similarly, recruiting patients with NMOSD, we found pooled percentages of SjS or SLE respectively of 7.0% and 3.5%. Our research found that the coexistence of these two disorders was more frequent in female rheumatologic patients with a SjS diagnosis with neurological manifestations and in neurologic patients for whom a SjS diagnosis was suspected. Similarly, NMOSD are less frequently found in SLE and very rarely incident in Mixed Connective Tissue Disease (MCTD) patients. These considerations should be taken into account in clinical experience of rheumatologists and neurologists, since early diagnosis of both conditions may influence the timing of immunosuppressive therapy and the prevention of systemic disabilities.

TAFRO syndrome associated with C3 nephropathy (an analysis of clinical experience)

Aim. To present a clinical case of TAFRO syndrome – a recently described subtype of idiopathic multicentric Castleman disease of unknown etiology, characterized by thrombocytopenia, anasarca, fever, reticulin fibrosis of the bone marrow and / or renal dysfunction, organomegaly associated with an increase in serum IL-6 secretion.Materials and methods. Herein, we report a young patient diagnosed with TAFRO combined with C3 nephropathy. The patient was treated with glucocorticoids (methylprednisolone), colchicine, sarilumab, rivaroxaban, and symptomatic treatment.Results. Key aspects of diagnosis, treatment and course of the syndrome were discussed. The possibility of the combined course of two rare pathologies – a subtype of idiopathic multicentric Castleman disease and C3 nephropathy is still unclear.Conclusion. The diagnosis of TAFRO syndrome can be considered after the exclusion of a number of infectious, paraneoplastic, systemic connective tissue diseases, POEMS syndrome, liver cirrhosis against the background of autoimmune hepatitis, autoimmune thrombocytopenic purpura, as well as hemolytic-uremic syndrome. Kidney damage in this category of patients, in most of the described clinical cases, is morphologically represented by thrombotic microangiopathy or mesangioproliferative glomerulonephritis. C3 nephropathy in that clinical case seems to be concomitant. Glucocorticoids in high and ultrahigh doses, cyclosporine, IL-6 type inhibitors, as well as anti-CD20 antibodies are used as therapy.

Scleroderma-overlap syndromes: capillaroscopy, laboratory, and clinical manifestations and follow-up compared to scleroderma patients.

Overlap syndrome (OS) is a group of systemic connective tissue diseases (CTDs) that meet the criteria of two or more CTDs. In this study, we evaluated clinical, laboratory, and capillaroscopic manifestations of patients with scleroderma OS (SSc-OS) and its subgroups and follow-up progression compared to patients with limited SSc (LcSSc). In a 10-year cross-sectional study, we evaluated 135 adult patients (70 with SSc-OS and 65 with LcSSc) with the same skin score for their baseline and follow-up clinical, laboratory, high-resolution chest tomography (HRCT), echocardiography, and nailfold capillaroscopy data and compared them. Of the 135 patients, 70 had SSc-OS, including 45 (64.3%) cases of SSc-SS (Sjögren's syndrome), 11 (15.7%) of SSc-RA (rheumatoid arthritis), 9 (12.9%) of SSc-myositis and 5 (1.7%) of SSc-SLE (systemic lupus erythematosus), and 65 had LcSSc. Lung and heart involvement and pulmonary arterial hypertension (PAH) did not differ between the two groups (p > 0.05). Musculoskeletal involvement and non-specific pattern of capillaroscopy were higher (p = 0.035 and p = 0.001), and digital ulcer (DU) and scleroderma patterns of capillaroscopy were lower in the SSc-OS group (p = 0.000).No significant relationship was found between capillaroscopic patterns and organ involvement in the two groups (p-value > 0.05). In the follow-up (3.71 ±2.63 years), new DU and progression of lung involvement (p = 0.002) and the progression in capillaroscopic patterns was lower in SSc-OS (p = 0.000). In the follow-up, new DU was not seen in the SSc-OS, with lower progression of lung involvement, skin score, and capillary damage. In SSc-OS patients, the most common subgroup was SSc-SS. Scleroderma OS was associated with lower major organ involvement and capillaroscopy progression than LcSSc. Major organ involvement in patients with SSc-OS was significantly lower than in LcSSc patients. In the follow-up, new DU was not seen in the SSc-OS with lower progression of lung involvement, skin score, and capillary damage.

A successful case of deceased-donor liver transplantation from a donor with Marfan syndrome: a case report

BackgroundLiver transplantation is the definitive therapy for patients with decompensated cirrhosis. Marfan syndrome is a systemic inheritable connective tissue disease associated with fibrillin-1 gene mutations, which cause abnormalities in connective tissue. Vascular changes due to Marfan syndrome occur mostly in the main vessels due to the high amount of connective tissue within the vessel wall and the high pressure and blood flow to which they are exposed. The incidence of changes in visceral arteries is about 0.42% and usually presents with cystic medial necrosis. This report is the first deceased-donor liver transplantation with a donor with Marfan syndrome with a history of abdominal surgery.Case presentationA patient in his 50s underwent liver transplantation for decompensated alcoholic cirrhosis. The donor, a 50s male with Marfan syndrome, was diagnosed with brain-death due to a cerebral hemorrhage caused by a cerebral aneurysm. The donor’s clinical presentation as Marfan syndrome was aortic dissection, with multiple surgical procedures performed from the aortic root to the abdominal aorta. An intraoperative biopsy of the hepatic artery showed no abnormality, so this organ was considered appropriate. The surgery was completed without any problems of the arterial anastomosis. The patient’s postoperative course was uneventful, and he was transferred to a hospital for recuperation on the 18th postoperative day. One year after the surgery, the patient is still alive without any complications from the transplantation or arterial problems.ConclusionsEven if the patient had a history of surgery for vascular anomalies extending to the abdominal aorta due to Marfan syndrome, the patient can be a donor for liver transplantation under appropriate judgment, including intraoperative biopsy.

The effect of long‐term use of gadgets on the condition of the bulbar conjunctiva in young people

Aims/Purpose: To evaluate the condition of the bulbar conjunctiva in young people by the method of impression cytology in response to long‐term use of gadgets.Methods: The research design consisted of 40 students (80 eyes) aged 18–20 years (19 ± 1.2). All students underwent general ophthalmological examinations, including blink rate per minute and impression cytology of the bulbar conjunctiva from the temporal side. Changes in the bulbar conjunctiva were evaluated according to Nelson's classification. Criterion for inclusion in the study: time spent on gadgets at least 6 h per day. Exclusion criteria: contact lens users, chronic eyelid diseases, diabetes, systemic connective tissue diseases, Sjögren's disease...).Results: Morphological and morphometric studies of the bulbar conjunctiva showed that most of the subjects (35 students, which is 87.5%) had a normal epithelial state of the front surface of the eye, which corresponds to 0–1 degrees according to Nelson, while 5 students had changes in the form of partial squamous metaplasia, which corresponded to the II degree according to Nelson and amounted to 12.5%. Blink frequency was reduced in 27 subjects, which was 67.5%. In most cases (n = 34, 85%) had a reduced blink frequency while working with gadgets, and 27 students (67.5%) had it reduced even without using digital devices.Conclusions: The results of our research showed that 12.5% of students had changes in the epithelium of the bulbar conjunctiva, corresponding to the II degree according to Nelson, which can be considered as adaptively compensatory processes, in response to long‐term use of gadgets. Therefore, it is necessary to prescribe moisturizing drops to young people, which do not contain preservatives, phosphates and buffers (for example, Thealoz duo).

Problems of systemic connective tissue diseases of childhood in historical perspective

The relevance of study systemic connective tissue diseases with juvenile onset for modern medicine is determined by the trend towards their growth in the population, the difficulty of early diagnosis, the rapid development of disability and a poor life prognosis. The article presents the main achievements in the study of this group of diseases in children, with an emphasis on the most significant issues from a practical point of view related to diagnosis, classification, clinical features and modern approaches to treatment.

Prevention and treatment of neonatal lupus – a literature review

Introduction: Neonatal lupus is a syndrome diagnosed in newborns whose mothers suffer from systemic connective tissue diseases with the presence of antibodies to Ro(SS-A) and La(SS-B) antigens. It most often manifests with skin lesions and cardiac conduction disturbances. The aim of the study was to analyse the risk factors for neonatal lupus based on a literature review. In addition, a number of recommendations were formulated for prevention and further management of affected mothers and their children. Materials and methods: We reviewed PubMed, ResearchGate and Google Scholar databases. A combination of keywords: lupus, pregnant, infant, heart block (according to Medical Subject Headings, MeSH) was used to identify relevant publications. Results: Given the lack of protocols for the diagnosis and treatment of neonatal lupus, ensuring that women can monitor foetal heart rate and quickly access obstetric care in the event of abnormal readings is an important aspect in the early diagnosis of the disease. The question of prevention and treatment remains open, but given the results of recent studies, recommendations on prevention and treatment of this syndrome have been designed. Conclusions: 1. Prophylactic maternal intake of hydroxychloroquine. 2. Weekly doppler ultrasound of the umbilical artery and echocardiography. 3. Planning delivery in specialised health care units. 4. Follow-up of the infant until 6–7 months of age.

Manifestations of systemic connective tissue diseases on the oral mucosa: a literature review

Annotation. Despite the modern high level of medical care, autoimmune connective tissue diseases cause a lot of questions among scientists and are a significant problem for society. At the same time, in the scientific works available today, little attention is paid to the manifestations of connective tissue diseases in the oral cavity and modern diagnostics of the main types of dental pathology in such patients, which would have great scientific and practical importance. Therefore, the purpose of the review article was to perform an analysis of the scientific literature regarding orofacial manifestations of autoimmune connective tissue diseases. When using the following databases: PubMed, Google Scholar, Scopus, Web of Science and various combinations of keywords and subject headings of MESH such as “oral manifestations”, “oral mucosal lesions”, “autoimmune diseases”, “rheumatic diseases”, “connective tissue diseases”, “systemic lupus erythematosus”, “rheumatoid arthritis”, “systemic sclerosis”, “Sjögren’s syndrome”, “dermatomyositis”, 40 articles were chosen, which corresponded to the purpose of the study. The search results indicate that there is a direct correlation between the duration of the main disease and the severity of oral symptoms. Pronounced hyposalivation and dryness of oral mucosa are the most similar common signs of autoimmune diseases, which contributes to functional disorders and diseases of oral cavity. Oral manifestations are quite often a side effect of the treatment of connective tissue diseases. The pathology of oral mucosa in autoimmune diseases remains not well-understood, so makes it difficult to clarify its pathogenesis in detail, that would allow for the development of justified measures of prevention and treatment.

Rituximab in the treatment of Graves’ disease and endocrine ophthalmopathy. Opportunities and limitations

Rituximab is a chimeric (mouse and human) monoclonal antibody against B-lymphocytes (CD20). This drug is widely used in rheumatology in the treatment of rheumatoid arthritis, Sjogren’s syndrome, some systemic connective tissue diseases and vasculitis, as well as in hematology in lymphoproliferative diseases. Administration of rituximab leads to depletion of B-lymphocytes through various mechanisms, including antibody-dependent and complementdependent cytotoxic effects, as well as the regulation of apoptosis. Considering the mechanism of autoimmune damage in Graves’ disease, an autoimmune thyroid disease accompanied by thyrotoxicosis and endocrine ophthalmopathy (an autoimmune lesion of the accessory apparatus of the eye), the use of rituximab may be effective in these diseases. The review considers the currently available results of studies on the use of various doses of rituximab in these diseases.

Chronic hepatitis B in hospitalized rheumatologic patients: problems of screening and reactivation of infection

Objective: to evaluate the completeness of screening for hepatitis B virus (HBV) infection in HBsAg-positive patients admitted to a rheumatology hospital and to follow the history of HBV reactivation/seroversion during antirheumatic therapy. Material and methods. The results of initial and repeated (if applicable) hospitalizations were analyzed in 80 patients with rheumatic diseases (RD), including 55 (69%) women and 25 (31 %) men, with Australian surface antigen (HBsAg), admitted to the V.A. Nasonova Institute of Rheumatology from January 1, 2020 to July 20, 2022 (30 months). Results and discussion. The total number of hospitalizations to the clinic during the observation period, including repeat admissions, was 13,681. The number of hospitalizations in 80 patients with HBV infection during the observation period, including repeat admissions, was 144, of which for systemic vasculitis – 6 (8 %), other systemic connective tissue diseases – 16 (20 %), osteoarthritis and post-traumatic changes of joints – 14 (15 %), inflammatory joint diseases – 42 (54 %). Cases of HBV reactivation/seroverion, both in anamnesis and during observation, were detected in 9 (11 %) patients, and most frequently (n = 5) they were registered during methotrexate therapy. Conclusion. HBV infection in patients with RD leads to significant difficulties in the selection of drug therapy, due to the risk of reactivation of the infection. The results obtained indicate incomplete screening of patients with RD for HBV infection during the preclinical phase. Further investigation is needed to develop clear recommendations for the management of patients with RD infected with HBV.

B-079 Identifying Heterogeneity of Systemic Connective Tissue Diseases by Applying Joint Dimension Reduction and Cluster Analysis to Immunomarkers

Abstract Background Accurate identification of systemic connective tissue diseases (SCTDs) can be challenging due to the heterogeneity of each disease. This study aims to explore the heterogeneity of different SCTDs by applying non-supervised learning to immunomarker data and proposes an alternative classification. Additionally, the study investigates the clinical implications of these different groups. Methods We utilized multiple correspondence analysis and k-means clustering to analyze the immunomarker data of patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and Sjögren’s syndrome (SS) in Taiwan between 2001 and 2016. To investigate the clinical correlations of the classification results, we conducted a comprehensive review of the clinical findings and compared the results across different groups. Results A total of 11 923 patients with the three SCTDs were classified into six distinct clusters based on their immunomarker patterns. In this clustering system, RA patients were predominantly grouped in cluster 1, whereas SLE and SS patients had a more dispersed distribution. Among patients with SLE, renal involvement was more frequent in clusters 3 and 6 (52% and 51%, respectively) than in other clusters, and discoid lupus was more frequent in cluster 3. Among SS patients, typical SS findings such as inflammation or infection of eyes and allergic reactions were more common in cluster 2 (54% and 51%, respectively). In contrast, patients in cluster 3 had more unspecified benign neoplasms (58%) and were more likely to experience immune disorders (63%). Conclusion The immunomarker-driven clustering yields an alternative classification result with new clinical insights. The data-driven approach would provide a more evidence-based classification and aid in a more accurate diagnosis and management for SCTDs.