Ankylosing spondylitis causes morphological or functional damage to the cardiovascular system in 22% of cases. Using modern methods of heart function research, such as Holter ECG monitoring, it is possible to detect rhythm and conduction disorders, long QT syndrome. Changes in the parameters of the QT interval, such as its duration and variance, can be considered as a predictor of the development of cardiovascular catastrophes and fatal arrhythmias. The article analyzes the values of QT/RR and QTc during Holter ECG monitoring in 92 patients diagnosed with Ankylosing spondylitis, depending on the stage of the disease, the activity of the pathological process, and seropositivity for HLA B27. There was a significant increase in QT/RR and QTc during the active and passive periods of Holter ECG monitoring in comparison with the control group. In patients with ankylosing spondylitis, ventricular arrhythmias were detected, which are associated with prolongation of the QT interval. Standardized Holter ECG monitoring in patients with Ankylosing spondylitis, taking into account the daily variance of the QT interval, can become a universal, minimally invasive and low-cost method for assessing the risk of cardiovascular disorders in patients with Ankylosing spondylitis.

Dual antiplatelet therapy (DAPT) using of acetylsalicylic acid and antagonists of platelet’s P2Y12 receptors is included in standards for treatment of patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Clopidogrel, prasugrel, and ticagrelor are the P2Y12 receptor inhibitors used as a component of DAPT. The aim of this review is to determine the most effective and the safest P2Y12 receptor inhibitor for treating patients with an invasive treatment strategy of ACS. The TRITON study compared clopidogrel and pragugrel efficacy and safety had demonstrated a significantly higher efficiency in reducing the risk of reaching the primary endpoint (including cardiovascular death, myocardial infarction and stroke) for prasugrel, but at the same time, the prasugrel group was reliably recorded higher rate of major bleeding. Comparison of the efficacy and safety of clopidogrel and ticagrelor was carried out in the PLATO study, where ticagrelor was shown to be more effective in reducing cardiovascular deaths and myocardial infarction, while the safety of the drugs was comparable. A subsequent ISAR-REACT 5 study proved higher efficacy of prasugrel compared to ticagrelor in reducing the risk of reaching a primary endpoint with comparable safety to the major bleeding risk. Baseline data represents that the most effective drug among P2Y12 receptor inhibitors as a component of DAPT for patients with an invasive treatment strategy is prasugrel, and the safest is clopidogrel, which can be considered in elderly patients.

Aim. To study a possible association between cryoglobulinemia and cardiovascular and peripheral vascular disease in patients with symptomatic cryoglobulinemic vasculitis and rheumatoid arthritis patients with elevated cryoglobulins. Methods. Analysis of the coexistent cardiovascular system diseases prevalence, heart and carotid arteries echocardiography data of 32 patients with cryoglobulinemic vasculitis, and 129 patients with rheumatoid arthritis depending on the fact of high cryoglobulins titers in the blood plasma compared to 32 healthy volunteers in the control group was conducted. Cryoglobulins isolation from the blood was performed using the A.E. Kalovidoris method in N.A. Konstantinova modification. Results. In patients with cryoglobulinemic vasculitis and rheumatoid arthritis with asymptomatic cryoglobulinemia a high frequency of hypertension prevalence (46.8 and 34.4%, respectively), ischemic heart disease (15.6 and 7.9%), congestive heart failure (9.4 and 10.5%), chronic venous insufficiency (53.1 and 23.7%) and postthrombophlebetic syndrome (28.1 and 18.4%) was observed. When analyzing ultrasound data in patients with cryoglobulinemic vasculitis and rheumatoid arthritis it has been found that the cryoglobulinemia is accompanied by left ventricular myocardial geometry violation (in 81.3 and 65.7% respectively versus 12.5% of patients in the control group), myocardial diastolic dysfunction (71 9 and 65.7% versus 15.6%), an increase in the proportion of patients with the «intima-media» complex thickening (78.1 and 36.8% versus 31.2%) and atherosclerotic plaques (34.4 and 13, 2% versus 6.2%) in the carotid arteries. Conclusion. Cryoglobulinemia can be considered as adjuvant risk factor for cardiovascular disease in patients with rheumatism.

BackgroundThe impairment of hip joints has significant prognostic value on functional status of patients with Ankylosing spondylitis (AS) [1]. One of possible yearly marker of hip joints structure damage in patients with AS may be changing in volume of hyaline cartilage [2]. But clinical significance of this marker in monitoring of hip joint structure changes during treatment is underinvestigated.ObjectivesTo investigate changes in width of hyaline cartilage of hip joints in patients with AS under treatment with sulfasalazine and adalimumab during 12 month.MethodsThe 53 patients with AS (42 male, 9 female, average age is 37.6 years old, duration of disease is 14–152 month) were included into study. All patients were treated by NSAIDs and sulfasalazine (2 g per day) at least 3 month before study. In treatment of 27 patients (1st group) was added adalimumab (40 mg subcutaneously every 2 weeks), other 26 patients (2nd group) were left on previous treatment regime. Patients were observed during 12 months of treatment including measurements of pain visual analog scale (VAS) in hip movements, maximal distance between ankles, pelvic X-ray and sonography of hip joints by 10–18 MHz probe. BASRI-Hips index was applied for radiographic estimation of structural damage of hip joints [3]. During sonography width of hip joint capsule and hyaline cartilage were measured. The Mann-Whitney-U test was used for comparison of changes in clinical and sonographic data between two groups of patients.ResultsAfter 12 month treatment period in patients of 1st group in comparison with patients of 2nd group more significant decrease of pain VAS during hip movements (on 27.3 [18.8; 32.5] mm vs 4.7 [0.5; 9.6] mm, p<0,01), increase of maximal distance between ankles (on 124.3 [92.3;145.6] mm vs 3.5 [1.2; 6.5] mm, p<0,05) and decrease of joint capsule width (on 2.4 [1.0; 3.6] mm vs 0.4 [0.0;1.1] mm, p<0,05) had been determined. In patients of 1st group width of hyalinic cartilage had been increased on 0.15 [0.4; 0.22] mm, while in patients of 2nd group width of hyalinic cartilage had been decreased on 0.8 [0.0; 1.4] mm (p<0,05). These cartilage changes were accompanied by decrease of mean BASRI-Hips index on 1 point in 2nd group and absence of changes of BASRI-Hips index in 1st group. The correlation between changes in width of hip hyalinic cartilage and pain VAS during movement in hip joints (r=-0.52 [0.38; 061]) and maximal distance between ankles (r=+0.47 [0.32; 0.60]) had been revealed.ConclusionsTreatment with adalimumab leads to decrease of clinical and sonographic signs of coxitis and improvement of hyaline cartilage structure. The increase of width of hip hyalinic cartilage correlates with clinical effect of treatment of coxitis in patients with AS. More prolonged observation is needed for analysis of correlation between changes in hyaline cartilage structure and radiographic progression of hip joints damage in AS.References Baraliakos X., Braun J. Hip involvement in ankylosing spondylitis: what is the verdict? Rheumatology 2009;49(1):3–4...

Background: Cryopyrin-Associated Periodic Syndrome (CAPS) is a variety of clinical variants of autoinflammatory diseases. The pathology is based on a mutation in the NLRP3 gene encoding the cryopyrin protein, which leads to the uncontrolled production of interleukin-1β. Particular attention should be paid to the rarity of this disease and the lack of clinical knowledge about it in therapeutic and rheumatological practice, which leads to an erroneous diagnosis and the appointment of ineffective treatment for a long time, leading to the progression of the disease and disability of the patient. Case Presentation: This article describes a clinical case of this disease. The first manifestations of the disease in a woman appeared from the age of 2 years, in the form of a rash and fever. Since school age, there have been signs of arthritis. By the age of 24, sensorineural hearing loss and pain in the spine were evident. The disease occurred under the clinical manifestations of spondyloarthritis. Its treatment with anti-inflammatory therapy did not give a stable result. Conclusion: From the analysis, we can conclude that patient M. from early childhood suffers from a severe Neonatal-onset Multisystem Inflammatory Disease of a genetic nature. For a long time, the patient was diagnosed with ankylosing spondylitis, and appropriate treatment was carried out without significant success. The correct diagnosis of CAPS was made only in 2018. This patient has conditions of both CAPS and AS together, which is a very rare association in rheumatological practice. The only treatment method that could stop the manifestations of the disease and prevent life-threatening kidney damage (amyloidosis) is the use of genetically engineered biological drugs, i.e., IL-1β inhibitors. The only drug of this group registered in Russia is canakinumab (Ilaris ®). From the moment of diagnosis to the present day, the patient is treated with the genetically engineered drug canakinumab (Ilaris ®) at a dose of 150 mg once every 8 weeks. 6 months after taking the drug, the patient went into complete clinical and laboratory remission.