Pleurisy and pericarditis as a cause of atypical chest pain in patients with in early post-COVID-19 period.

During the pandemic COVID-19, there has been an increase in the number of patients with non-anginal chest pain at cardiologist appointments. Objective. To assess the incidence of signs of pleurisy and pericarditis after COVID-19 in non-comorbid patients with atypical chest pain and describe their characteristics according to echocardiography and magnetic resonance imaging. Materials and methods. From February 2021 to January 2022, 200 outpatients were prospectively enrolled in the study, all of them suffered from a discomfort in the heart region for the first time after SARS-CoV-2 infection. Inclusion criteria: 18-50 years old, 5-12 weeks after SARS-CoV-2 infection, non-anginal chest pain. Exclusion criteria: pneumonia or signs of pulmonary thromboembolism, coronary heart disease, congestive heart failure or kidney disease, clinical or laboratory signs of myocarditis, oncopathology, radiation or chemotherapy of the chest in past medical history. A survey was conducted (yes/no) for the presence of general malaise, quality of life deterioration, hyperthermia, cough. Ultrasound examination of the pericardium and pleura to detect effusion or post-inflammatory changes was performed in accordance with the recommendations. Magnetic resonance imaging was performed if ultrasound imaging was poor or there was no evidence of pericardial or pleural involvement in patients with typical symptoms. Results. 82 women and 118 men were included. Median of age 39 [28-46] years old. Pericarditis was diagnosed in 152 (76%) patients, including effusive pericarditis in 119 (78%), myocarditis in 6 (3%) and myopericarditis in 49 (25%) patients, pleurisy was detected in 22 (11%) patients, exudative pleurisy - in 11 (5.5%) patients with a predominant unilateral lesion of the mediastinal-diaphragmatic region adjacent to the heart. Hyperthermia was recorded in 2.5% of cases, general malaise - in 60% and a decrease in the quality of life - in 84%. Conclusion. Serositis as a cause of atypical chest pain among young non-comorbid patients in early postCOVID was identified in 87% of patients. In the coming years, it is probably worthwhile to perform ultrasound of the pericardium and pleura in all patients with chest pain.Copyright © 2022 Infectious Diseases: News, Opinions, Training.

SWITCHING FROM IL-6R ANTAGONISTS TO OLOKIZUMAB, A DIRECT IL-6 INHIBITOR

BackgroundOlokizumab (OKZ), an IL-6 ligand inhibitor in doses of 64 mg every two weeks (q2w) or every 4 weeks (q4w) demonstrated significant improvements in signs and symptoms of RA. Due to lack of availability of the IL-6 receptor antagonists tocilizumab and sarilumab in the pandemic COVID-19 situation, RA patients (pts) were switched to OKZ as a registered drug in Russia in 2022.ObjectivesTo investigate safety and efficacy of OKZ after switching from an IL-6 receptor inhibitor in clinical practice.MethodsThis retrospective cohort study included available efficacy and safety data of OKZ in pts with RA after switching from tocilizumab (IV or SC) or sarilumab (SC) from 11 of participating centers.Efficacy assessments and routine biochemical data were analyzed using descriptive statistics – mean with standard deviation for continuous parameters and absolute and relative frequency for binary variables. AE were reported by participating centers according to pt's files. The statistical significance of data of the analyzed variable at a particular visit compared with previous visits or with the Switch visit was determined using paired t-test. Fisher's exact test or chi-square test was used to compare the proportion of pts with improvement/no change and worsening. All tests were 2-tailed, and a p-value <0.050 was considered statistically significant. As this is an observational study, the statistical criteria have not been pre-specified and therefore the data presented cannot be considered definitive but should be confirmed in future analyses.ResultsEfficacy and safety results were collected for 110 RA pts with a mean age of 47.8 (15.7) years, including 87 (79.1%) women. 77 (70.0%) pts were RF/ACPA positive. Mean RA duration was 13.1 (8.9) years and mean duration of treatment with an IL-6 receptor antagonist was 47.8 (30.0) months. Mean interval before switching was 54.7 (35.4) days with the main reason of unavailable IL6-R antagonist. Pts were treated with OKZ 64 mg q4w SC.Before initiation of OKZ, an increase of DAS28-CRP was observed due to a prolonged period after the last injection of the IL-6R inhibitor from 2.8 to 3.1 weeks in 32 pts on monotherapy who were transferred to OKZ faster (on average after 41.6 (23.8) days), and from 2.7 to 3.3 weeks in 73 pts on concomitant sDMARDs (60.0 (38.0) days). DAS28-CRP was improved to 2.8 on the second OKZ visit (S+1) in both groups. Response to OKZ was maintained over a period of 2 months with no difference between pts previously receiving an IL-6 R antagonist. Of note, lower disease activity based on DAS28-CRP of 2.5 and 2.6 was achieved after 8 weeks (S+2) of OKZ therapy compared to the previous IL-6R inhibitors treatment S-1 visit (P less 0.05) (Figure 1).Figure 1.Mean DAS28CRP over time, M(SD)[Figure omitted. See PDF]Abbreviation: S-2 and S-1 last visits before switching– S+1 and S+2 visits after switching,Treatment emergent AE occurred in 7 (6.4%) pts, the most common AE in 3 pts (2.7%) included arthralgia of hands and feet and transient leukopenia in 2 (1.8%) pts.Serious AE were reported by 1 (0.9%) pt (exacerbation of herpes infection that led to treatment discontinuation). No deaths were reported. There were no apparent differences in safety and efficacy outcomes between pts on OKZ monotherapy compared to combined treatment with csDMARDs. Only one pt was switched back to tocilizumab when it became available.Table 1.Summary of treatment emergent adverse events (safety population)NOKZ 64 mg q4w with MTX N=78OKZ 64 mg q4w monotherapy N=32Any AE51 carpal canal syndromeAny serious AE10Any AE leading to discontinuation of study drug10Any death00Any AE of special interest10Infections10Laboratory abnormalitiesHyperbilirubin-emiaALT, AST elevation less than 3 ULNALT, alanine transaminase;AST, aspartate transaminase;ULN, upper limit of normalConclusionIn pts with RA responding to an IL-6R antagonist, switching to OKZ was safe and well tolerated in clinical practice. The treatment response was maintained and in some pts disease activity moderately decreased in compariso to baseline level both in OKZ mono and combination therapy.Reference[1]J.Smolen, N Engl J Med 2022;387:715-726AcknowledgementsI have acknowledgements to Vinogradova I.B., Anoshenkova O.N., Antipova O.V., Baranov A.A., Bogdanova E.A., Grabovetskaya Y.Y., Ilivanova E.P.,Kalyagin A.N., Kushnir I.N., Lapkina N.A. Mokrousova M.V., Nesmeyanova O.B., Nikitina N.V., Shesternya P.A. and Yudina N.V.Disclosure of InterestsEugen Feist Consultant of: Abbvie, Eli Lilly, Galapagos, Medac, Novartis, Sanofi, Sobi, R-Pharm, Grant/research support from: Eli Lilly, Novartis, Pfizer, Evgeny Nasonov Consultant of: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer.

To the 100th Anniversary of the Birth of Academician V.A. Nasonova. Infections and Rheumatic Diseases: From the Past to the Future

In rheumatology, the problem of infectious pathology is quite acute. This is primarily due to the participation of various infectious agents in the development of immuno-inflammatory rheumatic diseases (IIRD), in which microorganisms play a trigger role, triggering the immunopathological mechanisms of inflammation. Vivid examples of such diseases are acute rheumatic fever and reactive arthritis. The infectious etiology of Lyme disease has been proven. An equally difficult task is the fight against comorbid infection (CI), which often complicates the course of many IIRD due to a violation of the immune status caused by both the background disease and the use of immunosuppressive drugs. The predominance of respiratory tract lesions in the structure of CI in patients with IIRD makes it necessary to use influenza and pneumococcal vaccines in them, since the risk of deaths from these infections among these patients is quite high. During the development of the COVID-19 pandemic, which has become a challenge to all mankind, a large number of new fundamental and medical problems have been revealed concerning the relationship between viral infection and many widespread chronic non-communicable diseases, among which IIRDs occupy an important position. As one of the methods of combating the current COVID-19 pandemic, great hopes are pinned on the widespread use of vaccination. The possibility of using monoclonal antibodies for pre-exposure prophylaxis of COVID-19, including in patients with IIRD, is discussed.Copyright © 2023 Ima-Press Publishing House. All rights reserved.

ADULT STILL'S DISEASE: NEW HORIZONS.

Still's disease in children (systemic juvenile idiopathic arthritis - JIA) and adult Still's disease (ASD) are considered as systemic autoinflammatory diseases of unknown etiology, which are based on similar immunopathogenetic mechanisms associated with genetically determined disorders of the mechanisms of innate immunity. ASD was first described 50 years ago by the English rheumatologist Eric George Lapthorne Bywaters. The molecular basis of ASD immunopathogenesis is the activation of innate immunity associated with NLRP3 inflammasome-dependent mechanisms of inflammation, characterized by the overproduction of "pro-inflammatory" cytokines - interleukin (IL) 1 and IL-18, inducing the synthesis of other proinflammatory inflammatory mediators. A review of new data concerning the mechanisms of immunopathology, clinical polymorphism, laboratory biomarkers and the possibilities of ASD pharmacotherapy is presented. Particular attention is paid to the prospects for the use of monoclonal antibodies to IL-1beta - canakinumab. The problems associated with the generality of clinical and laboratory disorders, pathogenetic mechanisms and pharmacotherapy of ASD and coronavirus disease 2019 (COVID-19) are considered.Copyright © 2021 Authors. All rights reserved.

ADULT STILL'S DISEASE: NEW HORIZONS.

Still's disease in children (systemic juvenile idiopathic arthritis - JIA) and adult Still's disease (ASD) are considered as systemic autoinflammatory diseases of unknown etiology, which are based on similar immunopathogenetic mechanisms associated with genetically determined disorders of the mechanisms of innate immunity. ASD was first described 50 years ago by the English rheumatologist Eric George Lapthorne Bywaters. The molecular basis of ASD immunopathogenesis is the activation of innate immunity associated with NLRP3 inflammasome-dependent mechanisms of inflammation, characterized by the overproduction of "pro-inflammatory" cytokines - interleukin (IL) 1 and IL-18, inducing the synthesis of other proinflammatory inflammatory mediators. A review of new data concerning the mechanisms of immunopathology, clinical polymorphism, laboratory biomarkers and the possibilities of ASD pharmacotherapy is presented. Particular attention is paid to the prospects for the use of monoclonal antibodies to IL-1beta - canakinumab. The problems associated with the generality of clinical and laboratory disorders, pathogenetic mechanisms and pharmacotherapy of ASD and coronavirus disease 2019 (COVID-19) are considered.Copyright © 2021 Authors. All rights reserved.

Pleurisy and pericarditis as a cause of atypical chest pain in patients with in early post-COVID-19 period

During the pandemic COVID-19, there has been an increase in the number of patients with non-anginal chest pain at cardiologist appointments. Objective. To assess the incidence of signs of pleurisy and pericarditis after COVID-19 in non-comorbid patients with atypical chest pain and describe their characteristics according to echocardiography and magnetic resonance imaging. Materials and methods. From February 2021 to January 2022, 200 outpatients were prospectively enrolled in the study, all of them suffered from a discomfort in the heart region for the first time after SARS-CoV-2 infection. Inclusion criteria: 18–50 years old, 5–12 weeks after SARS-CoV-2 infection, non-anginal chest pain. Exclusion criteria: pneumonia or signs of pulmonary thromboembolism, coronary heart disease, congestive heart failure or kidney disease, clinical or laboratory signs of myocarditis, oncopathology, radiation or chemotherapy of the chest in past medical history. A survey was conducted (yes/no) for the presence of general malaise, quality of life deterioration, hyperthermia, cough. Ultrasound examination of the pericardium and pleura to detect effusion or post-inflammatory changes was performed in accordance with the recommendations. Magnetic resonance imaging was performed if ultrasound imaging was poor or there was no evidence of pericardial or pleural involvement in patients with typical symptoms. Results. 82 women and 118 men were included. Median of age 39 [28–46] years old. Pericarditis was diagnosed in 152 (76%) patients, including effusive pericarditis in 119 (78%), myocarditis in 6 (3%) and myopericarditis in 49 (25%) patients, pleurisy was detected in 22 (11%) patients, exudative pleurisy – in 11 (5.5%) patients with a predominant unilateral lesion of the mediastinal-diaphragmatic region adjacent to the heart. Hyperthermia was recorded in 2.5% of cases, general malaise – in 60% and a decrease in the quality of life – in 84%. Conclusion. Serositis as a cause of atypical chest pain among young non-comorbid patients in early postCOVID was identified in 87% of patients. In the coming years, it is probably worthwhile to perform ultrasound of the pericardium and pleura in all patients with chest pain. © 2022 Infectious Diseases: News, Opinions, Training.

[Janus kinase inhibitors in immunoinflammatory rheumatic diseases].

Despite great advances in the diagnosis and treatment of immunoinflammatory rheumatic diseases, which have led to a significant improvement in the prognosis in many patients, the fundamental medical problems of this pathology the restoration of the quality of life and the reduction of mortality to the population level are far from being resolved. This served as a stimulus for the study of new approaches to the pharmacotherapy of IVRD, one of which is associated with the use of low molecular weight chemically synthesized drugs that inhibit intracellular "signaling" molecules Janus kinase. Modern advances regarding the use of Janus kinase inhibitors in the treatment of immunoinflammatory rheumatic diseases and COVID -19 are considered.

Coronavirus Infection 2019 (COVID-19) and Autoimmunity.

The pandemic of coronavirus disease 2019, etiologically associated with the SARS-CoV-2 virus, has drawn the attention of the medical community to new clinical and fundamental problems in the immunopathology of human diseases. During a detailed analysis of the clinical manifestations and immunopathological disorders in COVID-19, it became apparent that SARS-CoV-2 infection is accompanied by the development of a wide range of extrapulmonary clinical and laboratory disorders, some of which are characteristic of immunoinflammatory rheumatic diseases and other human autoimmune and autoinflammatory diseases. All this taken together served as a theoretical justification for the repositioning of anti-inflammatory drugs in COVID-19, previously specifically designed for the treatment of immunoinflammatory rheumatic diseases. The prospects for studying the autoimmune mechanisms of COVID-19 and the possibility of anti-inflammatory therapy are discussed.

THE ROLE OF INTERLEUKIN 1 IN THE DEVELOPMENT OF HUMAN DISEASES: FOCUS ON ANAKINRA (IL-1 RECEPTOR ANTAGONIST)

According to modern concepts, human immune-mediated inflammatory diseases (IMIDs), depending on the prevailing mechanisms of immunopathogenesis, are divided into two main categories – autoimmune and autoinflammatory. At the same time, both autoimmune and autoinflammatory mechanisms are involved in the pathogenesis of most IMIDs, the complex interaction of which is reflected in the polymorphism of clinical manifestations, course variants, outcomes, and therapy efficacy. It is assumed that hyperproduction of cytokines of the interleukin (IL) 1 family, which is one of the key regulators of innate immunity, determines the “crossover” between the mechanisms of autoinflammation and autoimmunity in IMIDs. Anakinra is currently used in clinical practice to suppress the pathological effects of IL-1. An analysis of the results of the clinical use of Anakinra indicates that treatment with this drug should be considered as a promising direction in the pharmacotherapy of systemic autoinflammatory diseases (SAIDs) and critical conditions in children and adults associated with the development of hyperinflammation. The main directions of the Anakinra clinical research program are presented, including: determining the place of the drug in the implementation of the "Treat to Target" strategy and personalization of therapy, primarily in patients with “resistant” (difficult-to-treat) subtype of rheumatoid arthritis and comorbid pathology, as well as with severe forms of microcrystalline arthritis;the possibility of using Anakinra to improve the early diagnosis of SAIDs in children and adults;creation of the Russian register of patients with SAIDs, who are potentially indicated for treatment with Anakinra.

INTERLEUKIN 18 IN IMMUNE-MEDIATED RHEUMATIC DISEASES AND COVID-19

Immune-mediated rheumatic diseases (IMRDs), based on the leading mechanisms of pathogenesis, are conditionally classified into autoimmune, autoinflammatory, and «mixed pattern». In the spectrum of cytokines involved in the development of the immunopathological process in IMRDs, the “pro-inflammatory” cytokine interleukin (IL) 18, a member of the IL-1 family, plays an important role in the regulation of T-helper (Th) 1-, Th2- and Th17- types of immune response that induces the synthesis of interferon (IFN) γ, other pro-inflammatory cytokines and chemokines. The possibility of determining the concentration of IL-18 in IMRDs is discussed to improve diagnosis, identify subtypes of diseases, and predict the effectiveness of pharmacotherapy. IL-18 is a promising target for anticytokine therapy, primarily in patients with high activity of inflammation associated with hyperactivation of innate immunity.

JANUS KINASE INHIBITORS IN IMMUNOINFLAMMATORY DISEASES: 10 YEARS OF CLINICAL PRACTICE IN RHEUMATOLOGY

Despite great advances in the diagnosis and treatment of Immune-mediated inflammatory diseases (IMIDs), which have led to a significant improvement in the prognosis in many patients, the central medical problems of this pathology - restoring the quality of life and reducing mortality to the population level - are far from being resolved. This served as a powerful stimulus for the study of new approaches to the pharmacotherapy of IMIDs, one of which is associated with the discovery of targets for small-molecule therapeutics that inhibit intracellular "signaling" molecules JAKs (Janus kinases). The current achievements, trends and recommendations regarding the use of JAK inhibitors in the treatment of IMIDs and also in the hyper-response phase of COVID-19 are reviewed.

PROSPECTS FOR THE USE OF MONOCLONAL ANTIBODIES TO INTERLEUKIN 23 GUSЕLKUMAB IN PSORIATIC ARTHRITIS: NEW DATA

Among the pathophysiological mechanisms of immune-mediated inflammatory diseases (IMIDs), specific attention has been paid to the abnormal activation of Th17 type immune response related to the dysregulated synthesis of cytokines forming the interleukin (IL)-23 and IL-17 axis. IL-23 blockade is an innovative approach to the treatment of psoriasis and psoriatic arthritis (PsA). Much of the interest has focused on guselkumab (GUS) (TREMFYA, Janssen, Johnson & Johnson, USA), a fully human IgG λ monoclonal antibody (mAb) targeting the p19 IL-23 subunit and the first-in-class treatment approved for patients with psoriasis and PsA. In patients with psoriasis, GUS is at least as effective as other biologic therapies for PsA and is superior to ustekinumab, an anti-IL-12/IL-23 mAb, and secukinumab, an anti-IL-17 mAb. Compared with TNF-α inhibitors, GUS therapy is less likely to cause infections and does not increase the risk of the reactivation of latent TB infection. The new GRAPPA guidelines (2021) recommend GUS (and other IL-23 inhibitors) for patients with PsA resistant to conventional disease-modifying antirheumatic drugs (DMARDs), who have peripheral arthritis, enthesitis, dactylitis, psoriatic skin and nail lesions. The paper discusses new data on the efficacy of GUS in patients resistant to TNF-α inhibitors, its benefits in patients with axial PsA, and safety during the COVID-19 pandemic.

VACCINATION AGAINST SARS-COV-2 IN RHEUMATIC DISEASES: SAFETY ISSUES

The problem of coronavirus disease 2019 (Coronavirus diseases, COVID-19) two years later still remains relevant both socially and medically. As one of the methods of combating the current COVID-19 pandemic, most experts rely on the widespread use of vaccination. However, the use of vaccines against SARS-CoV-2 in patients with rheumatic diseases (RD) raises a number of issues related to the effectiveness, immunogenicity, and safety of immunization, including leveling the risks of exacerbation of the underlying disease or the development of new autoimmune phenomena. For this reason it is very important to analyze data on the above-mentioned aspects in real time, especially given that patients of the rheumatology circle were excluded from the clinical development programs of vaccines against SARS-CoV-2. This review presents the results of last year’s research on the safety of vaccination against COVID-19 in patients with RS. A brief description of the main anticovedic vaccines is given. Post-vaccination adverse events were quite frequent after the first, second or both doses of vaccines in patients with RS, which is consistent with the data obtained in the general population. In general, the frequency of exacerbation of RD after vaccination against COVID-19 seems to be quite low (5–7%) and has no significant associations with a specific vaccine or anti-rheumatic therapy. At the same time, unambiguous interpretation of these data is difficult for at least three reasons: a) in many studies, only the symptoms developing after the first dose of the vaccine were taken into account;b) the time-limited post-vaccination follow-up period;c) significant discrepancies in the interpretation of exacerbations of the disease. Within the framework of the problem under consideration, there are still a lot of questions, the answers to which should be obtained in large prospective controlled studies.

B cell depletion in immune-mediated rheumatic diseases and coronavirus disease 2019 (Covid-19)

In patients with immune-mеdiated (autoimmune) rheumatic diseases (IMIRD), there are a number of factors (advanced age, uncontrolled inflammation, initially irreversible damage to internal organs, comorbid pathology, genetic and other factors) that can potentially lead to an increase in “sensitivity” to SARS-CoV -2 (severe acute respiratory syndrome coronavirus-2) and concomitant viral and bacterial infections, an increase in the risk of a severe course of COVID-19 (coronavirus disease 2019), a decrease in the effectiveness of therapy for both IMIRDs and COVID-19. An important area of pharmacotherapy for IMIRDs and other autoimmune diseases is associated with the use of anti-B-cell drugs, primarily rituximab (RTX), which is a chimeric (mouse/human) monoclonal antibody (mAb) to the CD20 antigen of B cells. At present, in Russia, the RTM biosimilar, acellbia (BIOCAD), is widely used, which is not inferior to RTX in terms of efficiency and safety. The problems of anti-B-cell therapy during the COVID-19 pandemic in relation to the risk of infection, severe course and insufficient effectiveness of vaccination against SARS-CoV-2 are considered. According to the recommendations of the Association of Rheumatologists of Russia, a more rigorous assessment of indications for induction and maintenance therapy of RTX therapy and harmonization of the timing of drug administration and vaccination is required. © 2021 Ima-Press Publishing House. All rights reserved.

The psychological state of the patients with rheumatic diseases and hospital workers during the coronavirus disease (COVID-19) outbreak

Background: Patients with rheumatic diseases are more likely to suffer from anxiety-depressive disorders and, in the context of the current coronavirus pandemic, are most likely to be more susceptible to stress response, depression, and anxiety. Objectives: to evaluate the frequency of anxiety-depressive symptoms and stress levels in patients with various rheumatic diseases (RD) and hospital workers of the Moscow Institute of Rheumatology in Russia Methods: 148 RD inpatients, mostly with rheumatoid arthritis (44 (30%)), spondyloarthritis (31 (21%)), systemic lupus erythematosus (28 (19%)), systemic sclerosis (10 (7%)), primary Sjögren syndrome (7 (5%)), polymyositis (6 (4%)), and 32 hospital workers of the Nasonova Research Institute of Rheumatology were screened using the DASS-21 (The Depression, Anxiety, Stress scales-21, Lovibond S.H. & Lovibond P.F. (1995)) in the period from July to November 2020. The majority of RD-patients and hospital workers were women (73 and 93% resp). The mean age (M±SD) of RD-patients and hospital workers was 43,2±16,2 and 40,7±14,6 years resp. Results: The frequency of depression (34,5% vs 34,4%), anxiety (41,9% vs 34,4%) and post-traumatic stress (27,7% vs 25,0%) in RD-patients were found to be comparable to that found among the hospital workers, and the level of anxiety was statistically significantly higher in patients (2,0 [1,0;6,0] vs 1,0 [0;4,5], p=0,038). There was no association of depression, anxiety and stress with RD activity. There was a weak positive correlation between the level of depression (R=0,30), anxiety (R=0,26) and stress (R=0,33) with a higher dose of glucocorticoids taken by patients, as well as a negative correlation between the severity of depression (R=-0,7) and stress (R=-0,17) with the age of patients and hospital workers. 19 (12,8%) of RD-patients and 7 (21,9%) of hospital workers had contracted COVID-19 in previous months. Survivors of the COVID-19, both among RD-patients and hospital workers, were more likely to experience symptoms of depression, anxiety and stress: accordingly, depression had 31,6% vs 27,9%, anxiety -47,4% vs 41,9% and stress -26,3% vs 28,7% RD-patients who had been ill or not, and among hospital workers: depression -28,6% vs 36,0%, anxiety -42,8% vs 28,0%, stress -42,8% vs 20,0%. 66,4% of RD-patients and 71,9% of hospital workers reported that the pandemic had a psychological impact on them. Conclusion: The COVID-19 pandemic has had and continues to have a significant negative psychological impact on both RD-patients and hospital workers. About 25-47% of patients and hospital workers experienced significant level of depression, anxiety and stress, and their frequency was higher in those who had contracted COVID-19.

“Post-COVID syndrome”: The focus is on musculoskeletal pain

Combating the consequences of COVID-19, a disease caused by the new coronavirus infection SARS-CoV-2, is a serious and very urgent task facing modern medicine. COVID-19 often has a severe course and is accompanied by multiple organ damage, systemic immune inflammation, coagulopathy, neuroendocrine and metabolic disorders. Even with a relatively favorable course, the consequences of SARS-CoV-2 infection can be degenerative changes in many organs (pulmonary fibrosis, cardiosclerosis), various functional and psychoemotional disorders. As a result, in 10-50% of patients, various unpleasant symptoms persist for a long time after the acute manifestations of COVID-19 subside and the virus is eliminated. This pathology is referred to as “post-COVID syndrome” (PCS). The main elements of PCS are chronic pain, fatigue, and psychoemotional problems. Functional disorders, autoimmune processes, and severe psychological distress after COVID-19 can cause the development and exacerbation of diseases characterized by chronic pain and fatigue, such as fibromyalgia and chronic fatigue syndrome. Therapy and prevention of PCS include correction of functional disorders, pain control, and consistent physical, psychological, and social rehabilitation.

Coronavirus disease 2019 (COVID-19) and immune-mediated rheumatic diseases. Recommendations of the association of rheumatologists of Russia

In mid-2021, the SARS-CoV-2 (Severe Acute Respiratory coronavirus 2) infection, which caused the coronavirus disease (COVID-19) pandemic, affected more than 157 million people in all regions of the world and led to more than 3.2 million deaths. It is assumed that elderly age, uncontrolled inflammation, anti-inflammatory therapy, comorbid pathology, genetic and other factors can potentially lead to an increase in “sensitivity” to viral and bacterial infections, including SARS-CoV-2. The new version of the recommendations of the Association of Rheumatologists of Russia formulates the main provisions concerning the tactics of managing patients with Immune-mediated Rheumatic Diseases during the ongoing COVID-19 pandemic.

[2019 Coronavirus disease (COVID-19): contribution of rheumatology].

The 2019 coronavirus disease (COVID-19) pandemic become a major challenge for humanity and a unique opportunity to get an idea of the real achievements of modern biology and medicine. In the course of the pandemic, a large number of new fundamental and medical issues have been revealed regarding the relationship between viral infection and many common chronic non-infectious diseases, among which immune-mediated rheumatic diseases (IMRD) occupy an important position. It is now well known that SARS-CoV-2 infection is accompanied by a wide range of extrapulmonary clinical and laboratory disorders, some of which are characteristic of IMRD and other autoimmune and autoinflammatory diseases in humans. The most severe consequence of alterations in regulation of the immunity in COVID-19 and IMRD is the so-called cytokine storm syndrome, which is defined as COVID-19-associated hyperinflammatory syndrome in COVID-19, and as macrophage activation syndrome in IMRD. The COVID-19-associated hyperinflammatory syndrome was used as a reason for drug repurposing and off-label use of a wide range of anti-inflammatory drugs, which have been specially developed for the treatment of IMRD over the past 20 years. Common immunopathological mechanisms and approaches to pharmacotherapy in COVID-19 and IMRD determined the unique place of rheumatology among medical specialties contributing to combat the COVID-19 pandemic. The article provides the basic provisions of the International and National Association of Rheumatologists and the Association of Rheumatologists of Russia (ARR) recommendations for management of patients with IMRD during the COVID-19 pandemic.

Problems of early diagnosis of systemic lupus erythematosus during the COVID-19 pandemic

Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease of unknown etiology, characterized by overproduction of organ-nonspecific autoantibodies to various components of the cell nucleus and cytoplasm and the development of immune-inflammatory damage to internal organs. The debut of SLE is preceded by an asymptomatic period, characterized by impaired immunological tolerance to its own autoantigens, determined by the multifaceted interaction of external, genetic and epigenetic factors, hormonal disorders, microbiome pathology, stress effects, etc. Development of a certain spectrum of clinical symptoms characteristic of SLE along with the detection of a reflects the progression of the immunopathological process in SLE, however, there is no generally accepted term that defines the patient’s condition, which has individual serological and clinical signs characteristic of this disease. In rheumatology, the concept of «incomplete» SLE is currently most often used. The problems of early diagnosis of SLE, clinical and laboratory predictors of the transformation of “incomplete” SLE into “reliable” SLE, difficulties in diagnosing SLE during the COVID-19 pandemic are considered. Particular attention is paid to the comparative characteristics of the immunopathological mechanisms of SLE and COVID-19. © 2021 Ima-Press Publishing House. All rights reserved.