Psoriatic arthritis (PsA) is a chronic immune-mediated disease from a group of spondyloarthritis, which is characterized by damage to the musculoskeletal system with a wide range of different clinical manifestations and is usually associated with psoriasis. Activation of the interleukin (IL) 23/IL17 axis plays a key role in the pathogenesis of PsA and psoriasis. When non-steroidal and synthetic disease-modifying antirheumatic drugs are insufficiently effective, biological drugs are recommended. In recent years, there have been considerable advances in PsA treatment with tumor necrosis factor-α (IFN-α) inhibitors and IL-12/23 inhibitors. However, in some cases, this therapy fails to provide the desired effect and a search for new treatments for PsA seems to be an urgent task. The paper desctibes a clinical case demonstrating the efficacy of the IL17A inhibitor ixekizumab in a patient with high PsA activity and recurrent uveitis in both eyes. Ixekizumab therapy resulted in positive changes as the reduced severity of articular syndrome and psoriasis and normalization of acute phase parameters. Assessing the activity of PsA over time when using ixekizumab during a year showed an average decrease in ESR from 72 to 19 mm/h, in CRP from 162.1 to 0 mg/L, BSA from 51 to 0.25%, PASI from 43. 6 to 0, DAPSA from 78.2 to 2, ASDAS-SRB from 5.11 to 1.12, BASDAI from 4.85 to 1, BASFI from 5.3 to 0.7, BASMI from 5.0 to 2.6, MASES from 6 to 0, LEI from 2 to 0, SPARCC from 6 to 0, and NAPSI from 28 to 8. Thus, this clinical case is an example of successful treatment with the IL17 inhibitor ixekizumab for PsA with recurrent uveitis in the patient who has previously received three drugs from the TNFα group without any effect.

Background:Despite of the development the criteria for the diagnosis of axial spondyloarthritis (axSpA) the problem of late axSpA diagnostics is not resolved. The difficulties in the assessment of MRI sacroiliitis (SI) could be of the reasons of axSpA diagnostic delay.Objectives:to evaluate the inconsistency in the assessment of sacroiliac joints MRI that was performed by a blinded and unblinded rheumatologists and a radiologists.Methods:The assessment of 80 magnetic-resonance tomograms of sacroiliac joints (SIJ) was performed by 4 independent readers, one which was blinded to clinical data radiologist (BR), another radiologist was informed that the study was performed for axSpA (unblinded radiologist - UR), another 2 readers were blinded to diagnosis rheumatologists. One of the rheumatologists was trained in SIJ MRI (BTRh), another rheumatologist was not trained specially in MRI of SIJ (BURh). The study was carried out on the magnetic resonance tomography (GE Discovery MR750W 3.0T) in T1 and STIR regimens. 65 MRI were performed in pts that fulfilled the ASAS criteria for the axSpA and history of active SII (bone marrow edema) on previous SIJ MRI. According CT of SIJ 25 (38.5%) of these pts had nr-axSpA, 22 (33.8%) had SI grade II / III, in 18 (27.7%) of the pts SI grade IV was detected. 15 MRI scans were performed in healthy volunteers who did not meet the ASAS 2009 criteria at the time of the study and had no CT changes in SIJ.The number of detected by each reader cases of active SII as defined by ASAS were analyzed with the calculation of the inter-reader reliability.Results:There was found that there was inter-reader reliability between results of blinded and unblinded radiologists (73.8%) with statistical differences in the number of detected and undetected signs of SII (p <0.05).The inter-reader reliability scores between the unblinded rheumatologist and the radiologist were 97.5% and did not have statistically significant statistical differences (p≥ 0.05).And for a trained rheumatologist and a blinded untrained rheumatologist it was 53.5% and had significant statistical differences (p<0.05).The results of 4 readers SIJ MRI assessments are presented at Table 1.Table 1.The results of MRI sacroiliitis assessments performed by blinded and unblinded radiologists and rheumatologistsBRUbRBtRhBURhRevealed SII in axSpA (n = 65), n(%)44 (67.7)*64 (98.5)#62(95.4)26 (40)*Undetected SII in axSpA (n = 65), n(15)21(32.3)*1(1,5)3(4.6)39(60)*Revealed SII in controls (n = 15), n(%)2 (13.3)*3 (20) #3(20)1(6.7)*Undetected SII in controls (n=15), n(%)13(86.7)*12(80) #12(80)14(93.3)**inter-reader reliability with the results of all another reader with p<0.05. # inter-reader reliability between unblinded radiologist (UR) and blinded treated rheumatologist (BtRh) with p<0.05. BURh – blinded untreated rheumatologist. BR – blinded radiologist.Conclusion:The better agreement in inter-reader reliability in MRI of SIJ assessment was detected between unblinded radiologist and trained blinded rheumatologist. Blinded radiologist had shown lower inter-reader agreement with another specialists. The lowest of all inter-reader agreement had shown untrained blinded rheumatologist. Special MRI of SII assessment trainings for rheumatologists and radiologists are unmet need for the improvement of in-time axSpA diagnostics.Disclosure of Interests:None declared.

Background:At the moment, a highly relevant issue is the course of SARS-CoV-2 infection in patients with rheumatic pathology, especially, those receiving therapy with biological disease modifying antirheumatic drugs.Objectives:of the current study to assess the prevalence and course of SARS-CoV-2 infection in patients receiving various biological disease modifying antirheumatic drugs.Methods:to assess the severity of the course of SARS-CoV-2, discharged epicrisis from hospitals or the conclusion of computed tomography were used. The average age of the patients ranged from 41.4 + 11.6 years. In the evaluated sample, 47 patients (49.47%) were males. Among the infected of SARS-CoV-2 were patients with rheumatoid arthritis - 45 (47.4%), spondyloarthritis - 39 (41.1%), systemic connective tissue diseases - 11 (11.5%).Results:Since March 2020, among the 1319 patients with rheumatic diseases observed at the St. Petersburg Center of therapy biological disease modifying antirheumatic drugs, 95 patients (7,2%) had SARS-CoV-2 infection. In 57,9% (55 patients) there was a mild course of infection, in 35,8% of cases (34 patients) - a moderate course, in 6,3% (6 patients) - a severe course. Inpatient treatment was received by 29,5% (28 patients). A favorable outcome was noted in 95.8%, and a lethal outcome in 4,2%. The use of interleukin-6 inhibitors was required in 2,1% of patients (2) due to the development of a cytokine storm. The structure of the received biological therapy in the severity of the course is shown in Table 1.Table 1.The structure of the received biological therapy in the severity of the course SARS-CoV-2 infectionMild courseCT-1 (<25%)CT-2 (25-50%)CT-3 (50-75%)CT-4 (>75%)TNF-α inhibitors, n (%)30 (31,6)11 (11,6)7 (7,3)3 (3,2)0 (0,0)anti B-cell therapy (rituximab), n (%)2 (2,1)1 (1,1)2 (2,1)1 (1,1)2 (2,1)Abatacept, n (%)3 (3.2)0 (0,0)2 (2,1)0 (0,0)0 (0,0)Janus kinase inhibitors, n (%)5 (5,3)1 (1,1)1 (1,1)0 (0,0)0 (0,0)Interleukin-6 inhibitors, n (%)6 (6,3)0 (0,0)0 (0,0)0 (0,0)0 (0,0)Interleukin-17 inhibitors, n (%)8 (8,4) 2 (2,1) 2 (2,1)0 (0,0)0 (0,0)Other, n (%)1 (1,1)4 (4,2)1 (1,1)0 (0,0)0 (0,0)Among 95 infected patients, who were observed in the center, 51 received therapy with TNF-α inhibitors (8.5% of the total number of patients receiving therapy), 8 - rituximab therapy (2.7%), 5 - abatacept (6.3%), 7 - Janus kinase inhibitors (0.9%), 6 – interleukin-6 inhibitors (9.2), 12 - interleukin -17 inhibitors (14.1%), 6 patients treated with other drugs (10%).Conclusion:Taking into account the SARS-CoV-2 pandemic, further study of the course of infection in patients with rheumatic diseases, including those receiving biological therapy, is required. More information is also needed on the safety and efficacy of vaccination in this patient population.Disclosure of Interests:None declared

Background:Genetic predisposition takes one of the main parts at pathogenesis of axial spondyloarthritis (axSpA). Currently, HLA-B27 is a single genetic marker that used in classification criteria of axSpA. However, the presence of HLA-B27 does not affect the activity of the disease. An alternative biomarker of axSpA activity could be an immunoglobulin (Ig) A antibody to an invariant chain peptide associated with class II human leukocyte antigen (HLA) (anti-CD74).Objectives:The goal is to determine genetic polymorphisms of IL17 alleles prevalence in patients (pts) with axSpA and their interrelations with the disease activity and concentration of IgA to CD74.Methods:In 48 patients with a reliable diagnosis of axSpA, aged 18 to 69 years ASDAS, BASDAI, BASFI were calculated. The polymorphisms of alleles of interleukin (IL)-17A197 a/g, IL-17F7 histidine (His)/arginine (Arg), IL-17F11139 c/g, HLA-B27 were evaluated. Serum concentration of IgA to CD74 was measured (the normal reference interval according to the instructions for the laboratory kit for serum IgA to CD74 is 0-12.0 U/L).Results:The mean age of pts was 45.1±14.2 years, male 72.9%, BASDAI 2.99±0.28, ASDAS 2.29±0.16 (Cronbach’s alpha for the scales – 0.830), IgA to CD74 16.9±11.0 mg/L. The most often found polymorphisms of interleukin-17 alleles demonstrated intable 1.Table 1.Interleukin-17 alleles’ polymorphisms in patients with axial spondyloarthritis, n=48IndicatorPts with presence of polymorphism, nIndicatorPts with presence of polymorphism, nIL-17A-197 AA14IL-17F7 his/his45IL-17A-197 GG18IL-17F7 his/arg 2IL-17A-197 GG16IL-17F7 arg/arg 1IL-17F-11139 CG26IL-17F-11139 CC22Exceeded levels of IgA to CD74 were identified at 96 pts (70.1%). The factor analysis showed a relationship between ASDAS (R=0.857), BASDAI (R=0.842), BASFI (R=0.857) and level of IgA to CD74 (R=0.667),(table 2).Table 2.Interrelations between serum concentration of IgA to CD74, the activity indices and genetic polymorphisms of interleukin-17 alleles in axSpA patients (factor loads), n=48IndicatorFactor loading (R)FactorFactor 1FactorFactor 1IgA аnti-CD740.5250.9250.667BASDAI0.7340.8160.842ASDAS0.6570.5760.857BASFI0.5450.820IL-17 F7 His/His-0.421IL-17F7 His/Arg0.6310.544An increase in the factor load indices for IgA to CD74 (R=0.925) was established, provided that the IL-17F genotype is homozygous for the his / arg allele (R=0.544). The genotypes IL-17F his/his showed an inverse interrelation with the increase in serum IgA to CD74 level (R=-0.421).Conclusion:Serum concentration of IgA to CD74 exceeded normal reference level in axSpA patients in 70.1% of cases that was associated with ASDAS and BASDAI levels. Presence of heterozygote IL-17F polymorphism in his/arg allele was associated with increasing serum concentration of IgA to CD74 and with increased disease activity (ASDAS and BASDAI). Decreasing of serum IgA to CD74 concentration, less axSpA activity (ASDAS and BASDAI) were found in patients with presence of heterozygote IL-17F polymorphism in his/his allele.Disclosure of Interests:Elizaveta Vasilenko: None declared, Maxim Korolev: None declared, Sergey Lapin: None declared, Irina Kholopova: None declared, Anna Dadalova: None declared, V Mazurov: None declared, Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: Pfizer, Novartis, AbbVie, JSC BIOCAD, Сelgene, MSD, Sanofi