Background A lot of clinical studies have shown the beneficial pleiotropic effects of statins: both associated with reduction of cardiovascular risk, and response to the locomotory system such as their effects on: apoptosis, inhibition of NF Kb, the inhibition of TNF alfa and IL6, beneficial effects on angiogenesis, NO/nitrous oxide/, BMP -2 synthesis, increasing bone mineral density, increasing the antioxidant enzymes, etc. Objectives Is there a correlation of the level of CRP, the intake of statin and the effect over the activity of the inflammatory joint diseases such as RA,AS,PsA. Methods We have observed 86 patients with RA, 23 with AS and 13 with psoriatic arthritis treated with Simvastatin at a standard dose of 20 mg. The basic treatment of these patients has not changed during the observation. Of these, 78 patients have been treated with biological DMARDS-anti TNF alpha - medication for 1 year and the remaining 8 patients have been receiving methotrexate monotherapy 10-12.5 mg. weekly dose. The evaluation of the activity is done respectively by DAS 28 for RA, CASPAR - for PsA and BASDAI the AS of 0,4, 8 and 12 weeks, the level of the CRP mg * l and total cholesterol-mmol * l are measured. Results A significant change with reduction of activity in patients with RA has been reported - in 58 patients DAS 28 - was reduced by an average of 1.2, in 28 patients with more than 1.2 in patients with PsA-CASPAR index is reduced by 1.3, in patients with AS BASDAI it is reduced by 2. There is a reduction in CRP values by 8 (4th week), and by 9mg * l (8th week), by 2 (12th week), the cholesterol level is reduced on average in all patients with 1,34 mmol * l from baseline. Conclusions Our observation has shown the effect of statins, particularly the effect of Sinvastatin on acute phase and the favorable effects of the implementation of their many pleiotropic effects, and in particular - the anti-inflammatory effects. At this stage, statins are not included in the recommendations for the treatment of these diseases, but perhaps in the future they will be, after the completion of numerous clinical studies and presentation of results. References Chiang CE, Pella D, Singh RB. Coenzyme Q10 and adverse effects of statins. J Nutritional and Environmental Med 2004; 14:1-12. Shepherd J. Fibrates and statins in the treatment of hyperlipidaemia: an appraisal of their efficacy and safety. Eur Heart J 1995; 16:5-13. Mason RP, Jacob RF. Membrane microdomains and vascular biology: emerging role in atherogenesis. Circulation 2003; 107:2270-3. McKenney JM, Jones PH, Adamczyk MA. For the STELLARStudy Group. Comparison of efficacy of rosuvastatin versus atorvastatin, simvastatin, and pravastatin in achieving lipid goals: results from the STELLAR trial. Curr Med Res Opin 2003; :557-66. Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low-density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ 2003;326: 1423. Disclosure of Interest None declared DOI ...

Introduction: The efficacy and safety of TNF-α blockers have been demonstrated in lot of clinical trials. The use of TNF-α blockers is associated with a significant improvement in the overall symptoms of patients with inflammatory joint diseases such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA). As a result of their use, the functions of affected joints and the quality of life of patients are improved. In recent years, it has been demonstrated that TNF-α blockers produce drug-induced neutralizing antibodies that reduce the effectiveness of these costly drugs. Objective: To investigate drug-induced neutralizing antibodies to TNF-α blockers in patients with inflammatory joint diseases followed by 24-months. Materials and Methods: 121 (56.8%) patients with PA, 50 (23.5%) patients with AS and 42 (19.7%) patients with PsA, treated with TNF-α blockers, were tested at 0, 6, 12, 24 months for drug-induced neutralizing antibodies. Detection of neutralizing antibodies to adalimumab (Humira) is performed by ELISA method, with Immundiagnostik - TNFα-Blocker-ADA, Antikorper gegen Adalimumab (Humira), Immundiagnostik AG, Stubenwald-Allee 8a, D 64625 Bensheim all requirements of the manufacturer. Determination of neutralizing antibodies to etanercept (Enbrel) were performed by ELISA method, with Immundiagnostik – TNF-α-Blocker-ADA, Antikorper gegen Etanercept (ENBREL), Immundiagnostik AG, Stubenwald-Allee 8a, D 64625 Bensheim, all requirements of the manufacturer. The SPSS v.24 statistical program was used. Results and conclusions: Drug-induced neutralizing antibodies in patients with RA, PsA, AS, treated with adalimumab, occurred in 11.5% of the patients 6th months after beginning of the treatment, at 12th months they were 17.64%, at the end of the second year 24.8 %. Patients treated with etanercept do not have proven neutralizing antibodies 6th months after beginning of the treatment, at the end of the first year they were 7.77%, at the end of the second year 9.63%. There is no significant difference between the number of males and females with drug-induced neutralizing antibodies (p=0.01). The number of patients with neutralizing antibodies to adalimumab and etanercept differ markedly in the 12th and 24th month (p=0.01). We recommend that the investigating of drug-induced neutralizing antibodies to TNF-α blockers have to be done every 12th months as a part of the routine work of rheumatologists.

Analyzing synovial fluid from joints affected by the pathological process of psoriatic arthritis is part of the overall patient examination, since it may have differential diagnostic significance. The purpose of this study was to assess the presence of crystals in the synovial fluid of psoriatic arthritis patients as biomarkers for disease activity. Materials and methods: The synovial fluid of 156 patients with proven PSA diagnosis (patients covered CASPAR criteria) was analyzed over 24 months and compared to 50 patients with activated gonarthrosis. The Leica DM4500P polarization microscope (Leica Microsystems, Germany) was used for crystal detection. Pain and disease activity measures were also evaluated (PSA VAS for pain, DAPSA, PASDAI, mCPDAI, and HAQ-DI). The statistical analysis was carried out using SPSS version 26 with a significance set at p < 0.05. Results: The macroscopic appearance of synovial fluid from patients with psoriatic arthritis was clear in 84.6% of the patients. Synovial fluid crystals were found in 23.71% of patients with psoriatic arthritis - predominantly monosodium urate (67.58%) but also calcium pyrophosphate (21.62%) and lipid drops (5.4%). The presence of monosodium urate crystals significantly correlates with all pain and disease activity measures – VAS for pain, DAPSA, PASDAI, mCPDAI, and HAQ-DI. In 67.56% of patients with established crystals treatment with an anti-TNF blocker was started at the discretion of the treating rheumatologist due to high levels of disease activity. Conclusion: Examining the synovial fluid in PSA patients is a necessary minimally invasive procedure in cases of joint effusion, since the presence of synovial fluid crystals is a significant indicator of disease severity. The current analyses demonstrate that the presence of synovial fluid crystals in PSA patients can be used as a biomarker for disease severity and the necessity to commence biological treatment (most often TNF-a-blocker).